Thomas Wilson Vinson, DDS

Individual provider Active NPI General Practice Dentistry · Murfreesboro, NC

NPI 1174556997 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1174556997
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
5143 (NC)
Practice address
112 E Broad St
Murfreesboro, NC 27855-1403
Phone
(252) 398-5143
Fax
(252) 398-4881
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20160523001742 NC Order and Referring Only - Dentist
Practitioner - Dentist
1052600509

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
5143NCMDCertified Registered Nurse Anesthetist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5143 NC Yes

Addresses

Primary practice location

112 E Broad St
Murfreesboro, NC 27855-1403

Mailing address

112 E Broad St
Murfreesboro, NC 27855-1403
Phone (252) 398-5143

Other identifiers

IdentifierTypeStateIssuer
7998775MedicaidNC

Other providers in Murfreesboro, NC

All providers in Murfreesboro, NC · General Practice Dentistry in North Carolina

Sources for this page

Verify at the official NPI Registry.