Provider Demographics
NPI:1871591883
Name:DINICK, VINCENT DAVID (MD,DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DAVID
Last Name:DINICK
Suffix:
Gender:M
Credentials:MD,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ARNET ST
Mailing Address - Street 2:STE. 180
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5753
Mailing Address - Country:US
Mailing Address - Phone:248-919-1100
Mailing Address - Fax:
Practice Address - Street 1:200 ARNET ST
Practice Address - Street 2:STE. 180
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5753
Practice Address - Country:US
Practice Address - Phone:248-919-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076963208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4361557Medicaid
MI4361557Medicaid
MI0P13990Medicare PIN