Provider Demographics
NPI:1700090347
Name:MCENTIRE, VENCEN WAYNE III (DDS)
Entity Type:Individual
Prefix:DR
First Name:VENCEN
Middle Name:WAYNE
Last Name:MCENTIRE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4312 TECKLA
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5413
Mailing Address - Country:US
Mailing Address - Phone:806-359-1644
Mailing Address - Fax:806-359-1722
Practice Address - Street 1:4312 TECKLA
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5413
Practice Address - Country:US
Practice Address - Phone:806-359-1644
Practice Address - Fax:806-359-1722
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11,2021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice