Provider Demographics
NPI:1851305247
Name:VINEYARD, BRIAN J (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:VINEYARD
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 1:910 WEST PHILLIP
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101
Mailing Address - Country:US
Mailing Address - Phone:308-532-8623
Mailing Address - Fax:
Practice Address - Street 1:333 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:NE
Practice Address - Zip Code:69165
Practice Address - Country:US
Practice Address - Phone:308-386-2236
Practice Address - Fax:308-386-3545
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47066065614Medicaid
NE05658OtherBLUE CROSS