Provider Demographics
NPI:1528030954
Name:DAUCHESS, VINCENT G (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:G
Last Name:DAUCHESS
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 1:401 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2930
Mailing Address - Country:US
Mailing Address - Phone:570-622-2036
Mailing Address - Fax:570-622-5242
Practice Address - Street 1:401 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2930
Practice Address - Country:US
Practice Address - Phone:570-622-2036
Practice Address - Fax:570-622-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018834-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0160922OtherKEYSTONE
PA0005170230001Medicaid
PA160922OtherBLUE SHIELD MEDICAL
PA01176001OtherCAPITAL BLUE CROSS
PA160922OtherBLUE SHIELD MEDICAL
PA0005170230001Medicaid