Provider Demographics
NPI:1376536201
Name:DEVIRGILIO, VINCENT JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:DEVIRGILIO
Suffix:JR
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 1:544 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2214
Mailing Address - Country:US
Mailing Address - Phone:781-326-2642
Mailing Address - Fax:
Practice Address - Street 1:544 CANTON ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2214
Practice Address - Country:US
Practice Address - Phone:781-326-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist