Provider Demographics
NPI:1093283160
Name:DR VINCENT D DIMENTO DMD
Entity Type:Organization
Organization Name:DR VINCENT D DIMENTO DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIMENTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-477-9960
Mailing Address - Street 1:4627 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3243
Mailing Address - Country:US
Mailing Address - Phone:315-477-9960
Mailing Address - Fax:315-423-0735
Practice Address - Street 1:4627 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3243
Practice Address - Country:US
Practice Address - Phone:315-477-9960
Practice Address - Fax:315-423-0735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR VINCENT DDIMENTO DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty