Provider Demographics
NPI:1295854917
Name:PRICE, VINCENT JARONE (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JARONE
Last Name:PRICE
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 1:6645 KIRBY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8327
Mailing Address - Country:US
Mailing Address - Phone:901-757-1025
Mailing Address - Fax:
Practice Address - Street 1:1440 E SHELBY DR
Practice Address - Street 2:SUITE# 5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7255
Practice Address - Country:US
Practice Address - Phone:901-332-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS38521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224796Medicaid