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General NPI Number Information
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NPI Number | 1003044264
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Entity Type | Organization
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Legal Business Name | VINCENT I. DISALVO, INC.
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 121 E 4TH ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6303
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Country | US
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Telephone | 570-322-4741
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Fax | 570-323-6110
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Provider Business Mailing Address
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Address Line | 121 E 4TH ST
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-6303
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Country | US
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Telephone | 570-322-4741
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Fax | 570-323-6110
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT I DISALVO
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Credential | D.D.S.
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Telephone | 570-322-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS015354L
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License Number State | PA
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