Provider Demographics
NPI:1003044264
Name:VINCENT I. DISALVO, INC.
Entity Type:Organization
Organization Name:VINCENT I. DISALVO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:I
Authorized Official - Last Name:DISALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-322-4741
Mailing Address - Street 1:121 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6303
Mailing Address - Country:US
Mailing Address - Phone:570-322-4741
Mailing Address - Fax:570-323-6110
Practice Address - Street 1:121 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6303
Practice Address - Country:US
Practice Address - Phone:570-322-4741
Practice Address - Fax:570-323-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015354L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty