Provider Demographics
NPI:1861402307
Name:MASCIA, VINCENT EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:EDWARD
Last Name:MASCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 STARCREST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7288
Mailing Address - Country:US
Mailing Address - Phone:434-977-4909
Mailing Address - Fax:
Practice Address - Street 1:332 STARCREST RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-7288
Practice Address - Country:US
Practice Address - Phone:434-977-4909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics