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Organization
VINCENT J MONTICCIOLO
Active
Organization
VINCENT J MONTICCIOLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINCENT J MONTICCIOLO DDS (OWENER)
(727) 849-4246
Entity
Organization
Contact information
Practice address
4530 GRAND BLVD, NEW PORT RICHEY, FL 34652-5119
(727) 849-4246
Mailing address
4530 GRAND BLVD, NEW PORT RICHEY, FL 34652-5119
(727) 849-4246
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-BO47 N
DENTI MAX
FL
01
—
36771
BLUE CROSS BLUE SCHEILD
FL
Enumeration date
05/02/2008
Last updated
05/02/2008
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