Provider Demographics
NPI:1255340931
Name:VINCENT, JAY W (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:W
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 1:5410 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-2914
Mailing Address - Country:US
Mailing Address - Phone:409-963-0008
Mailing Address - Fax:409-963-0002
Practice Address - Street 1:5410 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-2914
Practice Address - Country:US
Practice Address - Phone:409-963-0008
Practice Address - Fax:409-963-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics