Provider Demographics
NPI:1245501410
Name:MONTICCIOLO FAMILY AND SEDATION DENTISTRY, PA
Entity type:Organization
Organization Name:MONTICCIOLO FAMILY AND SEDATION DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MONTICCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MBA
Authorized Official - Phone:727-422-2801
Mailing Address - Street 1:8327 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3805
Mailing Address - Country:US
Mailing Address - Phone:813-885-3345
Mailing Address - Fax:813-885-3117
Practice Address - Street 1:8327 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3805
Practice Address - Country:US
Practice Address - Phone:813-885-3345
Practice Address - Fax:813-885-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL014899261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental