Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 18119 | OH |
NPI | 1083731129 |
---|---|
Provider Name | Dr. Vincent Louis Fiorita |
First Address | Wooster, OH 44691-1246 |
Second Address | Wooster, OH 44691-1246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 03/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0976207 | (05) | OH |
43436 | (02) |