Provider Demographics
NPI:1538239256
Name:VINCENT G. DAUCHESS, D.D.S, P.C
Entity type:Organization
Organization Name:VINCENT G. DAUCHESS, D.D.S, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:DAUCHESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-622-2036
Mailing Address - Street 1:401 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2930
Mailing Address - Country:US
Mailing Address - Phone:570-622-2036
Mailing Address - Fax:570-622-5242
Practice Address - Street 1:401 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2930
Practice Address - Country:US
Practice Address - Phone:570-622-2036
Practice Address - Fax:570-622-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018834-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA529243OtherATENA
PA614756OtherBLUE SHIELD MEDICAL
PA0012807780002Medicaid
PA02340400OtherCAPITAL BLUE CROSS
PAA60922OtherAMERIHEALTH
PA529243OtherATENA