Healthcare Provider Details

I. General information

NPI: 1558749655
Provider Name (Legal Business Name): JOHN VASKO JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MUNSON LN
WEST SAYVILLE NY
11796
US

IV. Provider business mailing address

151 WEST CHESTER HALL SUNY AT STONY BROOK HOSPITAL DENTISTRY
STONY BROOK NY
11794
US

V. Phone/Fax

Practice location:
  • Phone: 631-563-1583
  • Fax:
Mailing address:
  • Phone: 631-444-2557
  • Fax: 631-444-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number058831
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: