Healthcare Provider Details

I. General information

NPI: 1457541112
Provider Name (Legal Business Name): RICHARD VUONG D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POCONO RD STE 116
DENVILLE NJ
07834-2905
US

IV. Provider business mailing address

16 POCONO RD STE 116
DENVILLE NJ
07834-2905
US

V. Phone/Fax

Practice location:
  • Phone: 973-627-1220
  • Fax:
Mailing address:
  • Phone: 973-627-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22DI02353000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: