Theron Lane Vines Jr., D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

34009 Issued in CO

Practice address

303 Brookside Ave
Redlands, CA 92373-4607

Phone

(909) 793-8837

Fax

(909) 335-0497

NPI assigned

Jul 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Terry L Vines Jr. Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972517217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 BROOKSIDE AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734607",
            "telephone_number": "909-793-8837",
            "fax_number": "909-335-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 BROOKSIDE AVE",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734607",
            "telephone_number": "909-793-8837",
            "fax_number": "909-335-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINES",
        "first_name": "THERON",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "34009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRY",
            "last_name": "VINES",
            "middle_name": "L",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "D.D.S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Redlands, CA
• Providers in Redlands, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.