Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 12314 | MA |
N | 213EG0000X | General Practice | 12314 | MA |
N | 1223P0700X | Prosthodontist | 12314 | MA |
N | 1223X0400X | Orthodontists | 12314 | MA |
NPI | 1033242979 |
---|---|
Provider Name | Dr. Vincent Karl Trossello |
First Address | Quincy, MA 02169-5514 |
Second Address | Quincy, MA 02169-5514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 09/07/2007 |