Provider Demographics
NPI:1588858906
Name:DR RONNIE MCVAE VINSON DDS MPH PC
Entity Type:Organization
Organization Name:DR RONNIE MCVAE VINSON DDS MPH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:MCVAE
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:504-282-3354
Mailing Address - Street 1:2136 MIRABEAU AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122
Mailing Address - Country:US
Mailing Address - Phone:504-282-3354
Mailing Address - Fax:504-283-8326
Practice Address - Street 1:2136 MIRABEAU AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122
Practice Address - Country:US
Practice Address - Phone:504-282-3354
Practice Address - Fax:504-283-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1826707122300000X
GA8916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1826707Medicaid
LA1826707Medicaid