Provider Demographics
NPI:1518011204
Name:PALERMO, VINCENT PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:PALERMO
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 1:6782 MANATEE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7435
Mailing Address - Country:US
Mailing Address - Phone:704-847-7426
Mailing Address - Fax:704-847-5417
Practice Address - Street 1:2435 PLANTATION CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5147
Practice Address - Country:US
Practice Address - Phone:704-847-7426
Practice Address - Fax:704-847-5417
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996579Medicaid