Provider Demographics
NPI:1184767816
Name:VINCENT, RONALD D (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:D
Last Name:VINCENT
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 1:306 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7579
Mailing Address - Country:US
Mailing Address - Phone:970-242-6623
Mailing Address - Fax:970-242-6627
Practice Address - Street 1:306 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81501-7579
Practice Address - Country:US
Practice Address - Phone:970-242-6623
Practice Address - Fax:970-242-6627
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02034502Medicaid