Provider Demographics
NPI:1841406758
Name:CONTI, VINCENT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:CONTI
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 1:499 JERICHO TPKE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1136
Mailing Address - Country:US
Mailing Address - Phone:516-280-2802
Mailing Address - Fax:516-747-6049
Practice Address - Street 1:499 JERICHO TPKE
Practice Address - Street 2:SUITE 106
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1136
Practice Address - Country:US
Practice Address - Phone:516-280-2802
Practice Address - Fax:516-747-6049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00893861Medicaid