Healthcare Provider Details

I. General information

NPI: 1497896492
Provider Name (Legal Business Name): VERNON J. GOIN D.D.S. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 W RYAN ST SUITE D
BRILLION WI
54110-1076
US

IV. Provider business mailing address

964 W RYAN ST SUITE D
BRILLION WI
54110-1076
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-3313
  • Fax:
Mailing address:
  • Phone: 920-756-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1437G
License Number StateWI

VIII. Authorized Official

Name: DR. VERNON JOHN GOIN
Title or Position: DENTIST
Credential: D.D.S.
Phone: 920-756-3313