Provider Demographics
NPI:1023403821
Name:GOIN, VERNON (DDS)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:
Last Name:GOIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:VERNON
Other - Middle Name:JOHN
Other - Last Name:GOIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
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:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist