Provider Demographics
NPI:1386179497
Name:AQUINO, VINCENT MARIO (DDS, MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MARIO
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MAIN ST.
Mailing Address - Street 2:119 SQUIRE HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-899-6637
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST.
Practice Address - Street 2:119 SQUIRE HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-899-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0637861223S0112X
TX391431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery