Provider Demographics
NPI:1386701381
Name:VINCENT P. PHILLIPINO, DDSPC
Entity type:Organization
Organization Name:VINCENT P. PHILLIPINO, DDSPC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PHILLIPINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-548-1667
Mailing Address - Street 1:16 BRAMBLE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-1667
Mailing Address - Fax:
Practice Address - Street 1:16 BRAMBLE BUSH DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11057OtherBLUE CROSS BLUE SHIELD
MA16541OtherHARVARD PILGRIM HEALTH
MAX06269Medicare ID - Type Unspecified