Individual
DR. PHILIP ANDREW VICINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2018 MARTINS BRANCH DRIVE, SISSONVILLE, WV 25312
(303) 984-0052
(304) 984-3140
Mailing address
4 DOGWOOD DR, KENNA, WV 25248-9666
(304) 984-0052
(304) 984-3140
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV2958
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0133023000
—
WV
Enumeration date
10/20/2006
Last updated
07/09/2007
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