Provider Demographics
NPI:1386616654
Name:DEANGELIS, VINCENT P JR (DMD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:P
Last Name:DEANGELIS
Suffix:JR
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 1:1320 ALLAIRE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3504
Mailing Address - Country:US
Mailing Address - Phone:732-663-1988
Mailing Address - Fax:732-663-1240
Practice Address - Street 1:1320 ALLAIRE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3504
Practice Address - Country:US
Practice Address - Phone:732-663-1988
Practice Address - Fax:732-663-1240
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI187271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice