Provider Demographics
NPI:1083037444
Name:DR. VINCENT VISSICHELLI & ASSOCIATES, D.M.D., P.A.
Entity Type:Organization
Organization Name:DR. VINCENT VISSICHELLI & ASSOCIATES, D.M.D., P.A.
Other - Org Name:FIREHOUSE KID'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:VISSIEHELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:910-778-8485
Mailing Address - Street 1:213 SKYLAND PLAZA SUITE 1370-212
Mailing Address - Street 2:FIREHOUSE KID'S DENTISTRY
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390
Mailing Address - Country:US
Mailing Address - Phone:910-778-8485
Mailing Address - Fax:910-778-8477
Practice Address - Street 1:2980 RAY ROAD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390
Practice Address - Country:US
Practice Address - Phone:910-778-8485
Practice Address - Fax:910-778-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty