Healthcare Provider Details

I. General information

NPI: 1376536201
Provider Name (Legal Business Name): VINCENT JOSEPH DEVIRGILIO JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 CANTON ST
WESTWOOD MA
02090-2214
US

IV. Provider business mailing address

544 CANTON ST
WESTWOOD MA
02090-2214
US

V. Phone/Fax

Practice location:
  • Phone: 781-326-2642
  • Fax:
Mailing address:
  • Phone: 781-326-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17497
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: