Provider Demographics
NPI:1275840035
Name:TERRY L. VINCENT, DDS, INC.
Entity Type:Organization
Organization Name:TERRY L. VINCENT, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-596-6395
Mailing Address - Street 1:136 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9271
Mailing Address - Country:US
Mailing Address - Phone:831-596-6395
Mailing Address - Fax:
Practice Address - Street 1:136 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAKS
Practice Address - State:CA
Practice Address - Zip Code:95076-9271
Practice Address - Country:US
Practice Address - Phone:831-596-6395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22558314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22558OtherDENTAL LICENSE NUMBER