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General NPI Number Information
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NPI Number | 1811163660
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Entity Type | Organization
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Legal Business Name | JAMES A VACCA DDS MSCO PA
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 1316 DAVIE AVE SUITE C
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City | STATESVILLE
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State | NC
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Zip | 28677
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Country | US
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Telephone | 704-872-0969
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Fax | 704-872-0960
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Provider Business Mailing Address
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Address Line | 1316 DAVIE AVE SUITE C
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City | STATESVILLE
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State | NC
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Zip | 28677
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Country | US
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Telephone | 704-872-0969
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Fax | 704-872-0960
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Authorized Official
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Title or Position | PRES
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Name | DR. JAMES ANTHONY VACCA
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Credential | DDS MSC O
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Telephone | 704-872-0969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | NC3727
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License Number State | NC
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