Provider Demographics
NPI:1760499354
Name:VINCENT, DANIEL J (DDS PC GP)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DDS PC GP
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Mailing Address - Street 1:3850 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5220
Mailing Address - Country:US
Mailing Address - Phone:770-449-5999
Mailing Address - Fax:770-242-7050
Practice Address - Street 1:3850 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5220
Practice Address - Country:US
Practice Address - Phone:770-449-5999
Practice Address - Fax:770-242-7050
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA12255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist