Provider Demographics
NPI:1346868361
Name:DEBORAH VINCENT DMD PSC
Entity Type:Organization
Organization Name:DEBORAH VINCENT DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-324-1117
Mailing Address - Street 1:2741 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1928
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6492OtherLICENSE
KY6492OtherKENTUCKY BOARD OF DENTISTRY