Provider Demographics
NPI:1841793601
Name:VINING, VICTORIA ASHLYN (DMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ASHLYN
Last Name:VINING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-2413
Mailing Address - Country:US
Mailing Address - Phone:256-383-0377
Mailing Address - Fax:
Practice Address - Street 1:121 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-2413
Practice Address - Country:US
Practice Address - Phone:256-383-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAPPLYING1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice