Provider Demographics
NPI:1639136526
Name:LAPORTA, VINCENT NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:NICHOLAS
Last Name:LAPORTA
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 1:360 TOLLAND TPKE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1771
Mailing Address - Country:US
Mailing Address - Phone:860-646-1429
Mailing Address - Fax:860-646-6897
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-646-1429
Practice Address - Fax:860-646-6897
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92461223P0300X
RI28231223P0300X
RIDEN028231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics