Provider Demographics
NPI:1114265410
Name:VINSON, SCOTT RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RICHARD
Last Name:VINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 COTTONWOOD ST
Mailing Address - Street 2:S-5
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-4362
Mailing Address - Country:US
Mailing Address - Phone:530-662-3994
Mailing Address - Fax:
Practice Address - Street 1:1204 COTTONWOOD ST
Practice Address - Street 2:S-5
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4362
Practice Address - Country:US
Practice Address - Phone:530-662-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist