Provider Demographics
NPI:1871641340
Name:TAVORMINA, VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:TAVORMINA
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 1:96 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1944
Mailing Address - Country:US
Mailing Address - Phone:973-761-5090
Mailing Address - Fax:973-761-5097
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:973-761-5090
Practice Address - Fax:973-761-5097
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ113361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice