Provider Demographics
NPI:1477668143
Name:SCOTT M. VINES, DDS, PLLC
Entity Type:Organization
Organization Name:SCOTT M. VINES, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-342-1581
Mailing Address - Street 1:1123 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5313
Mailing Address - Country:US
Mailing Address - Phone:336-342-1581
Mailing Address - Fax:336-349-7350
Practice Address - Street 1:1123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5340
Practice Address - Country:US
Practice Address - Phone:336-342-1581
Practice Address - Fax:336-349-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899007XMedicaid