Provider Demographics
NPI:1326146317
Name:MARY L. VINCKIER, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARY L. VINCKIER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINCKIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-387-2262
Mailing Address - Street 1:333 GORDON DR.
Mailing Address - Street 2:SUITE B
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097
Mailing Address - Country:US
Mailing Address - Phone:810-387-2262
Mailing Address - Fax:810-387-4207
Practice Address - Street 1:333 GORDON DR.
Practice Address - Street 2:SUITE B
Practice Address - City:YALE
Practice Address - State:MI
Practice Address - Zip Code:48097
Practice Address - Country:US
Practice Address - Phone:810-387-2262
Practice Address - Fax:810-387-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty