Provider Demographics
NPI:1669688826
Name:FUSCHINO, VINCENT F (DDS)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:F
Last Name:FUSCHINO
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 1:42 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118
Mailing Address - Country:US
Mailing Address - Phone:518-664-4903
Mailing Address - Fax:518-664-2411
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118
Practice Address - Country:US
Practice Address - Phone:518-664-4903
Practice Address - Fax:518-664-2411
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00419916Medicaid
10005071OtherCDPHP