Provider Demographics
NPI:1659520377
Name:VINES, SCOTT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:VINES
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 1:2018 NEW GARDEN ROAD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-540-0026
Mailing Address - Fax:336-540-0036
Practice Address - Street 1:2018 NEW GARDEN ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-540-0026
Practice Address - Fax:336-540-0036
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899007XMedicaid