Provider Demographics
NPI:1609249044
Name:JOHN VININGS, DDS, P.A.
Entity Type:Organization
Organization Name:JOHN VININGS, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VININGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-748-9797
Mailing Address - Street 1:2811 S LOOP 289 STE 12
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1443
Mailing Address - Country:US
Mailing Address - Phone:806-748-9797
Mailing Address - Fax:
Practice Address - Street 1:2811 S LOOP 289 STE 12
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1443
Practice Address - Country:US
Practice Address - Phone:806-748-9797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty