Provider Demographics
NPI:1235220948
Name:VINCENT, DEBORAH E (DMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:VINCENT
Suffix:
Gender:F
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0069
Mailing Address - Country:US
Mailing Address - Phone:606-324-1117
Mailing Address - Fax:606-324-2336
Practice Address - Street 1:2741 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1928
Practice Address - Country:US
Practice Address - Phone:606-324-1117
Practice Address - Fax:606-324-2336
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064920Medicaid