Healthcare Provider Details

I. General information

NPI: 1871960757
Provider Name (Legal Business Name): VULTAGGIO DENTISTRY OF CORAL SPRINGS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 W SAMPLE RD
CORAL SPRINGS FL
33065-3941
US

IV. Provider business mailing address

10339 W SAMPLE RD
CORAL SPRINGS FL
33065-3941
US

V. Phone/Fax

Practice location:
  • Phone: 954-840-1940
  • Fax: 954-840-1941
Mailing address:
  • Phone: 954-840-1940
  • Fax: 954-840-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN18316
License Number StateFL

VIII. Authorized Official

Name: FRANCESCO VULTAGGIO
Title or Position: PRESIDENT
Credential: DMD
Phone: 954-840-1940