Provider Demographics
NPI:1760658413
Name:VINCENT J MONTICCIOLO
Entity Type:Organization
Organization Name:VINCENT J MONTICCIOLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTICCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-849-4246
Mailing Address - Street 1:4530 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5119
Mailing Address - Country:US
Mailing Address - Phone:727-849-4246
Mailing Address - Fax:
Practice Address - Street 1:4530 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5119
Practice Address - Country:US
Practice Address - Phone:727-849-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL36771OtherBLUE CROSS BLUE SCHEILD
FL1-BO47 NOtherDENTI MAX