Healthcare Provider Details

I. General information

NPI: 1700082096
Provider Name (Legal Business Name): TODD L. VACCARO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 UNION ST
NISKAYUNA NY
12309-6311
US

IV. Provider business mailing address

8 WYNGATE DR
GLENMONT NY
12077-3132
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-3628
  • Fax:
Mailing address:
  • Phone: 518-225-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: