Provider Demographics
NPI:1477711604
Name:THOMAS C VINEY DDS SC
Entity Type:Organization
Organization Name:THOMAS C VINEY DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:VINEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-534-2686
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4305
Mailing Address - Country:US
Mailing Address - Phone:262-534-2686
Mailing Address - Fax:262-534-2686
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4305
Practice Address - Country:US
Practice Address - Phone:262-534-2686
Practice Address - Fax:262-534-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI368G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty