Provider Demographics
NPI:1811022734
Name:GOYMERAC, VINCENT ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:GOYMERAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 ROCHESTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0726
Mailing Address - Country:US
Mailing Address - Phone:909-944-2800
Mailing Address - Fax:
Practice Address - Street 1:8215 ROCHESTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0726
Practice Address - Country:US
Practice Address - Phone:909-944-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4017079OtherTIN NUMBER
CA45-5152055OtherEIN