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General NPI Number Information
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NPI Number | 1447517180
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Entity Type | Organization
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Legal Business Name | MARK B. VECCHIO, D.D.S.
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 200 ORCHARD AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1737
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Country | US
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Telephone | 304-842-3577
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Fax | 304-842-3231
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Provider Business Mailing Address
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Address Line | 200 ORCHARD AVE
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1737
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Country | US
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Telephone | 304-842-3577
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Fax | 304-842-3231
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Authorized Official
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Title or Position | OWERER
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Name | DR. MARK BRIAN VECCHIO
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Credential | D.D.S.
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Telephone | 304-842-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2779
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License Number State | WV
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