Provider Demographics
NPI:1851477814
Name:VAIL, MARK VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:VINCENT
Last Name:VAIL
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 1:4224 LINDSEY DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8844
Mailing Address - Country:US
Mailing Address - Phone:785-317-0245
Mailing Address - Fax:
Practice Address - Street 1:1629 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4148
Practice Address - Country:US
Practice Address - Phone:785-776-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND98631223P0700X
KS601721223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics