Provider Demographics
NPI:1467559849
Name:VINCKIER, MARY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:VINCKIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 DRIVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01316801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice