Individual
VINCENT T. VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5316 CENTRAL FLORIDA PKWY, ORLANDO, FL 32821-8772
(407) 239-9557
Mailing address
8749 THE ESPLANADE APT 27, ORLANDO, FL 32836-7736
(503) 750-9718
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D 8293
OR
1223P0221X
Pediatric Dentistry
Primary
DN19534
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004545000
—
FL
Enumeration date
09/25/2005
Last updated
04/24/2013
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