Provider Demographics
NPI:1205908977
Name:CAREY, VINCENT M (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
Last Name:CAREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:479-333-2336
Mailing Address - Fax:479-333-6750
Practice Address - Street 1:700 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:479-333-2336
Practice Address - Fax:479-333-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0110391223S0112X
GADN0110391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000774056EMedicaid
GA000774056EMedicaid
GA85BBBDBMedicare Oscar/Certification
GAU69469Medicare PIN