Provider Demographics
NPI:1114011954
Name:PICCININO, MICHAEL VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:PICCININO
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 1:10682 CRESTWOOD DR STE C
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-4401
Mailing Address - Country:US
Mailing Address - Phone:703-368-8120
Mailing Address - Fax:703-361-5053
Practice Address - Street 1:10682 CRESTWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4401
Practice Address - Country:US
Practice Address - Phone:703-368-8120
Practice Address - Fax:703-361-5053
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010077851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics