Provider Demographics
NPI:1508272915
Name:VINCENT, TODD STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:STEVEN
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 N TOWN EAST BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4151
Mailing Address - Country:US
Mailing Address - Phone:972-270-7210
Mailing Address - Fax:
Practice Address - Street 1:2114 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2807
Practice Address - Country:US
Practice Address - Phone:801-467-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202233122300000X
TX337491223G0001X
UT9236046-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist