Provider Demographics
NPI:1548464977
Name:DEVINCENTIS, VINCENT PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:DEVINCENTIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3031
Mailing Address - Country:US
Mailing Address - Phone:973-338-3700
Mailing Address - Fax:973-338-7560
Practice Address - Street 1:1218 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3031
Practice Address - Country:US
Practice Address - Phone:973-338-3700
Practice Address - Fax:973-338-7560
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist