Provider Demographics
NPI:1447517180
Name:MARK B. VECCHIO, D.D.S.
Entity type:Organization
Organization Name:MARK B. VECCHIO, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWERER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:VECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-842-3577
Mailing Address - Street 1:200 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1737
Mailing Address - Country:US
Mailing Address - Phone:304-842-3577
Mailing Address - Fax:304-842-3231
Practice Address - Street 1:200 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1737
Practice Address - Country:US
Practice Address - Phone:304-842-3577
Practice Address - Fax:304-842-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty