Provider Demographics
NPI:1700274271
Name:BRIAN J. VINEYARD, D.D.S., P.C.
Entity Type:Organization
Organization Name:BRIAN J. VINEYARD, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VINEYARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-386-2236
Mailing Address - Street 1:PO BOX 797
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-0797
Mailing Address - Country:US
Mailing Address - Phone:308-386-2236
Mailing Address - Fax:308-386-4545
Practice Address - Street 1:333 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:NE
Practice Address - Zip Code:69165-3000
Practice Address - Country:US
Practice Address - Phone:308-386-2236
Practice Address - Fax:308-386-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty