Provider Demographics
NPI:1336127851
Name:ATKINSON, VINCENT BRADLEY (DMD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:BRADLEY
Last Name:ATKINSON
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 1:2618 MERCHANTS WALK
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2863
Mailing Address - Country:US
Mailing Address - Phone:615-217-7878
Mailing Address - Fax:615-217-9809
Practice Address - Street 1:2618 MERCHANTS WALK
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-2863
Practice Address - Country:US
Practice Address - Phone:615-217-7878
Practice Address - Fax:615-217-9809
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7905122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103863OtherDORAL PROVIDER ID #
TN3205693Medicaid