Provider Demographics
NPI:1235365180
Name:VINE, DAVID (DAVID VINE DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:VINE
Suffix:
Gender:M
Credentials:DAVID VINE DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3516
Mailing Address - Country:US
Mailing Address - Phone:305-538-1115
Mailing Address - Fax:305-538-1129
Practice Address - Street 1:400 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 403
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:305-538-1115
Practice Address - Fax:305-538-1129
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist