Healthcare Provider Details

I. General information

NPI: 1619980745
Provider Name (Legal Business Name): VIKKI LOUISE NOONAN D.M.D., D.M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIKKI LOUISE VAUGHN D.M.D., D.M.SC.

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE 6TH FLOOR;HARVARD VANGUARD MEDICAL ASSOC.;DEPT OF PATH.
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE 6TH FLOOR;HARVARD VANGUARD MEDICAL ASSOC.;DEPT OF PATH.
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-2844
  • Fax: 617-421-2423
Mailing address:
  • Phone: 617-421-2844
  • Fax: 617-421-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number19519
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: