Provider Demographics
NPI:1992725378
Name:CESARIO, VINCENT ANTHONY JR (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:CESARIO
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:28800 NYS RT 3
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-0820
Mailing Address - Country:US
Mailing Address - Phone:315-773-4204
Mailing Address - Fax:315-773-3126
Practice Address - Street 1:28800 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:NY
Practice Address - Zip Code:13612-2140
Practice Address - Country:US
Practice Address - Phone:315-773-4204
Practice Address - Fax:315-773-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice