Provider Demographics
NPI:1710089545
Name:VINCENT A TRIMBOLI JR DDS PC
Entity Type:Organization
Organization Name:VINCENT A TRIMBOLI JR DDS PC
Other - Org Name:PEDIATRIC DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRIMBOLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-525-6626
Mailing Address - Street 1:52 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028
Mailing Address - Country:US
Mailing Address - Phone:413-525-6626
Mailing Address - Fax:413-525-1133
Practice Address - Street 1:52 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-6626
Practice Address - Fax:413-525-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174451223P0221X
MA208421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty