Provider Demographics
NPI:1033242979
Name:TROSSELLO, VINCENT KARL (DMD,MSCD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:KARL
Last Name:TROSSELLO
Suffix:
Gender:M
Credentials:DMD,MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5514
Mailing Address - Country:US
Mailing Address - Phone:617-471-1890
Mailing Address - Fax:617-471-7310
Practice Address - Street 1:165 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5514
Practice Address - Country:US
Practice Address - Phone:617-471-1890
Practice Address - Fax:617-471-7310
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123141223G0001X, 1223P0700X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics