Provider Demographics
NPI:1013083633
Name:NOONAN, VINCENT C
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:C
Last Name:NOONAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 US HIGHWAY 130 STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4810
Mailing Address - Country:US
Mailing Address - Phone:732-297-0549
Mailing Address - Fax:
Practice Address - Street 1:2003 US HIGHWAY 130 STE C
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4810
Practice Address - Country:US
Practice Address - Phone:732-297-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO083421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDIO08342OtherDENTAL LICENSE NUMBER