1477745594 NPI number — VINCENT F. FIORENTINO, DDS, PC

Table of content: (NPI 1477745594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477745594 NPI number — VINCENT F. FIORENTINO, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT F. FIORENTINO, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477745594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21907 WESTERNPORT RD SW STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERNPORT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21562-2234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-786-7340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21907 WESTERNPORT RD SW STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERNPORT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21562-2234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-786-7340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIORENTINO
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-786-7340

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  11300 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 325021 . This is a "ANTHEM BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2120491 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6502 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 772611 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".