Provider Demographics
NPI:1619003829
Name:IACONO, VINCENT JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:IACONO
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 1:110 ROCKLAND HALL-PERIODONTICS
Mailing Address - Street 2:SCHOOL OF DENTAL MEDICINE-STONY BROOK UNIVERSITY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8703
Mailing Address - Country:US
Mailing Address - Phone:631-632-8895
Mailing Address - Fax:631-632-3113
Practice Address - Street 1:110 ROCKLAND HALL-PERIODONTICS
Practice Address - Street 2:SCHOOL OF DENTAL MEDICINE-STONY BROOK UNIVERSITY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8703
Practice Address - Country:US
Practice Address - Phone:631-632-8895
Practice Address - Fax:631-632-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0298661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics