Provider Demographics
NPI:1063685147
Name:SARACCO, VINCENT THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:THOMAS
Last Name:SARACCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SPEIGLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-1124
Mailing Address - Country:US
Mailing Address - Phone:518-237-0047
Mailing Address - Fax:
Practice Address - Street 1:290 SPEIGLETOWN RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1124
Practice Address - Country:US
Practice Address - Phone:518-237-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034978-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice