Provider Demographics
NPI:1144324278
Name:VINCENT, STEPHEN KIRK (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KIRK
Last Name:VINCENT
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 1:4811 BOB BILLINGS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3851
Mailing Address - Country:US
Mailing Address - Phone:785-841-2902
Mailing Address - Fax:785-841-5312
Practice Address - Street 1:4811 BOB BILLINGS PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3851
Practice Address - Country:US
Practice Address - Phone:785-841-2902
Practice Address - Fax:785-841-5312
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS63621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116521OtherPTAN
KST44089Medicare UPIN
KS116521VIMedicare ID - Type Unspecified