Provider Demographics
NPI:1235261173
Name:DIMENTO, VINCENT DOMINIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DOMINIC
Last Name:DIMENTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3301
Mailing Address - Country:US
Mailing Address - Phone:315-477-9960
Mailing Address - Fax:
Practice Address - Street 1:4627 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3301
Practice Address - Country:US
Practice Address - Phone:315-477-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist