Provider Demographics
NPI:1669624839
Name:LIPOMA, VINCENT JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:LIPOMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HUCK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4123
Mailing Address - Country:US
Mailing Address - Phone:973-338-1120
Mailing Address - Fax:
Practice Address - Street 1:30 HUCK RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4123
Practice Address - Country:US
Practice Address - Phone:973-338-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist