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General NPI Number Information
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NPI Number | 1285660340
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Entity Type | Organization
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Legal Business Name | COSMETIC DENTISTRY OF STUART, PLLC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 725 SE 5TH ST
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City | STUART
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State | FL
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Zip | 34994-2359
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Country | US
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Telephone | 772-220-3720
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Fax | 772-221-0574
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Provider Business Mailing Address
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Address Line | 725 SE 5TH ST
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City | STUART
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State | FL
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Zip | 34994-2359
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Country | US
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Telephone | 772-220-3720
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Fax | 772-221-0574
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. NICHOLAS A VINCENZO
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Credential | D.D.S.
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Telephone | 772-220-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN10184
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License Number State | FL
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