Provider Demographics
NPI:1174836274
Name:BILELLO, VINCENT JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JAMES
Last Name:BILELLO
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 1:106 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3405
Mailing Address - Country:US
Mailing Address - Phone:516-353-9980
Mailing Address - Fax:
Practice Address - Street 1:6534 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6212
Practice Address - Country:US
Practice Address - Phone:718-386-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0529081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics