Provider Demographics
NPI:1699958389
Name:COLONNA, VINCENT (DMD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:COLONNA
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 1:602 INMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067
Mailing Address - Country:US
Mailing Address - Phone:732-381-4650
Mailing Address - Fax:732-381-4661
Practice Address - Street 1:602 INMAN AVENUE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067
Practice Address - Country:US
Practice Address - Phone:732-381-4650
Practice Address - Fax:732-381-4661
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist