Provider Demographics
NPI:1033109988
Name:FAILLA, VINCENT PA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PA
Last Name:FAILLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-7413
Mailing Address - Country:US
Mailing Address - Phone:781-894-3143
Mailing Address - Fax:781-736-0712
Practice Address - Street 1:976 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7413
Practice Address - Country:US
Practice Address - Phone:781-894-3143
Practice Address - Fax:781-736-0712
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice