Provider Demographics
NPI:1164555223
Name:MONTICCIOLO, VINCENT (DDS, MBA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MONTICCIOLO
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:DR
Other - First Name:JULES
Other - Middle Name:D
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8327 W. HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-885-3345
Mailing Address - Fax:813-885-3117
Practice Address - Street 1:8327 W. HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-885-3345
Practice Address - Fax:813-885-3117
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1073646105OtherDR. MAI