Provider Demographics
NPI:1245374768
Name:REA, VINCENT J (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:REA
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 1:520 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2002
Mailing Address - Country:US
Mailing Address - Phone:856-778-4061
Mailing Address - Fax:
Practice Address - Street 1:282 NORTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1347
Practice Address - Country:US
Practice Address - Phone:609-871-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ89041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice