1053317552 NPI number — DR. VINCENT F. FIORENTINO D.D.S.

Table of content: (NPI 1316186364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317552 NPI number — DR. VINCENT F. FIORENTINO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIORENTINO
Provider First Name:
VINCENT
Provider Middle Name:
F.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1053317552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
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
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
WESTERNPORT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21562-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-729-2513
Provider Business Mailing Address Fax Number:
301-786-4037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21907 WESTERNPORT RD SW
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
WESTERNPORT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21562-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-729-2513
Provider Business Practice Location Address Fax Number:
301-786-4037
Provider Enumeration Date:
06/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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 "TRIGON BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2120491 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 772611 . This is a "UCCI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6502 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".