Provider Demographics
NPI:1497896492
Name:VERNON J. GOIN D.D.S. S.C.
Entity Type:Organization
Organization Name:VERNON J. GOIN D.D.S. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-756-3313
Mailing Address - Street 1:964 W RYAN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1076
Mailing Address - Country:US
Mailing Address - Phone:920-756-3313
Mailing Address - Fax:
Practice Address - Street 1:964 W RYAN ST
Practice Address - Street 2:SUITE D
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1076
Practice Address - Country:US
Practice Address - Phone:920-756-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1437G261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental