Provider Demographics
NPI:1437142999
Name:AUTH, VINCENT GERARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:GERARD
Last Name:AUTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 LAREDO ST
Mailing Address - Street 2:.
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-2173
Mailing Address - Country:US
Mailing Address - Phone:760-434-0014
Mailing Address - Fax:
Practice Address - Street 1:1ST DENTAL BATTALION
Practice Address - Street 2:BLDG 13128
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:760-763-1128
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026376L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics