Provider Demographics
NPI:1194872895
Name:PLACEK, VINCENT D (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:D
Last Name:PLACEK
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 1:615 COVE RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4818
Mailing Address - Country:US
Mailing Address - Phone:304-748-0700
Mailing Address - Fax:
Practice Address - Street 1:615 COVE RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4818
Practice Address - Country:US
Practice Address - Phone:304-748-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice