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General NPI Number Information
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NPI Number | 1437282357
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE DENTAL PROSTHETIC ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 165 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5514
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Country | US
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Telephone | 617-471-1890
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Fax | 617-471-7310
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Provider Business Mailing Address
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Address Line | 165 WASHINGTON ST
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City | QUINCY
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State | MA
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Zip | 02169-5514
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Country | US
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Telephone | 617-471-1890
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Fax | 617-471-7310
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VINCENT KARL TROSSELLO
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Credential | D.M.D.,M.SC.D.
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Telephone | 617-471-1890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 12314
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12314
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12314
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License Number State | MA
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