Provider Demographics
NPI:1376664615
Name:VICCO DENTAL CENTER, P.S.C.
Entity Type:Organization
Organization Name:VICCO DENTAL CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-476-8121
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:VICCO
Mailing Address - State:KY
Mailing Address - Zip Code:41773-0100
Mailing Address - Country:US
Mailing Address - Phone:606-476-8121
Mailing Address - Fax:606-476-9541
Practice Address - Street 1:35 LONGFIELD CIRCLE
Practice Address - Street 2:
Practice Address - City:VICCO
Practice Address - State:KY
Practice Address - Zip Code:41773
Practice Address - Country:US
Practice Address - Phone:606-476-8121
Practice Address - Fax:606-476-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY66731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45608718Medicaid