Provider Demographics
NPI:1427100858
Name:SMITH, VINCENT COLE
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:COLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VINCE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3687 LAS POSAS RD
Mailing Address - Street 2:DOS CAMINOS PLAZA
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1482
Mailing Address - Country:US
Mailing Address - Phone:805-484-2705
Mailing Address - Fax:805-484-5908
Practice Address - Street 1:3687 LAS POSAS RD
Practice Address - Street 2:DOS CAMINOS PLAZA
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1482
Practice Address - Country:US
Practice Address - Phone:805-484-2705
Practice Address - Fax:805-484-5908
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics