Healthcare Provider Details

I. General information

NPI: 1437282357
Provider Name (Legal Business Name): SOUTH SHORE DENTAL PROSTHETIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WASHINGTON ST
QUINCY MA
02169-5514
US

IV. Provider business mailing address

165 WASHINGTON ST
QUINCY MA
02169-5514
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-1890
  • Fax: 617-471-7310
Mailing address:
  • Phone: 617-471-1890
  • Fax: 617-471-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12314
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number12314
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12314
License Number StateMA

VIII. Authorized Official

Name: MR. VINCENT KARL TROSSELLO
Title or Position: PRESIDENT
Credential: D.M.D.,M.SC.D.
Phone: 617-471-1890