Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401007785 | VA |
NPI | 1114011954 |
---|---|
Provider Name | Dr. Michael Vincent Piccinino |
First Address | Manassas, VA 20109-4401 |
Second Address | Manassas, VA 20109-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |