Provider Demographics
NPI:1982694758
Name:DALESSIO, VINCE F (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCE
Middle Name:F
Last Name:DALESSIO
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 1:239 RIFLE CAMP RD
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3363
Mailing Address - Country:US
Mailing Address - Phone:973-477-7124
Mailing Address - Fax:973-471-8575
Practice Address - Street 1:503 PAULISON AVE
Practice Address - Street 2:DENTAL PLAZA PA
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3163
Practice Address - Country:US
Practice Address - Phone:973-471-4500
Practice Address - Fax:973-471-8575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI016958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1667807Medicaid