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General NPI Number Information
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NPI Number | 1811364284
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Entity Type | Organization
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Legal Business Name | STEPHEN M VICALVI DDS
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1100 E MAIN ST STE D
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City | MONTROSE
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State | CO
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Zip | 81401-4064
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Country | US
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Telephone | 970-240-2720
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Fax | 970-240-2724
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Provider Business Mailing Address
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Address Line | 1100 E MAIN ST STE D
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City | MONTROSE
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State | CO
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Zip | 81401-4064
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Country | US
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Telephone | 970-240-2720
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Fax | 970-240-2724
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN M JVICALVI
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Credential | DDS
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Telephone | 970-901-9822
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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 | 00007603
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License Number State | CO
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