Basic Information
| Provider Information | |||||||||
| NPI: | 1154954931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINSON AND ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7045 ASHLEIGH MANOR CT | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223154757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144835172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2345 MARTIN LUTHER KING JR AVE SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200205821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026105690 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2020 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | VINSON | ||||||||
| AuthorizedOfficialFirstName: | RACHEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 6144835172 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
ID Information
| ID | Type | State | Issuer | Description | 089247800 | 05 | DC | MEDICAID |