Dr. Vincent Mack

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DR. VINCENT MACK

Practice address

3347 S Airport Rd W Ste D
Traverse City, MI 49684-7939

Phone

(231) 929-7737

NPI assigned

Apr 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kaleena Ruth Slade

Title

Office Manager

Phone

(231) 929-7737

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vincent Peter Mack, DDS

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1790854354
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1275274649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3347 S AIRPORT RD W STE D",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847939",
            "telephone_number": "231-929-7737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3347 S AIRPORT RD W STE D",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847939",
            "telephone_number": "231-929-7737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. VINCENT MACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-07",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "SLADE",
        "authorized_official_first_name": "KALEENA",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-929-7737",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.