Provider Demographics
NPI:1700863271
Name:VISSICHELLI, VINCENT PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:VISSICHELLI
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 1:73 PINERIDGE COVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332
Mailing Address - Country:US
Mailing Address - Phone:919-499-4408
Mailing Address - Fax:
Practice Address - Street 1:73 PINERIDGE COVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:919-499-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD34811223P0221X
NC83631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD3481OtherDENTAL LICENSE
NC8363OtherDENTAL LICENCE