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General NPI Number Information
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NPI Number | 1134171010
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Entity Type | Individual
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Provider Name | MARK VAGNETTI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 320 WINDING RIVER LN SUITE 302
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3569
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Country | US
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Telephone | 434-260-7025
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Fax | 888-980-9982
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Provider Business Mailing Address
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Address Line | 320 WINDING RIVER LN SUITE 302
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3569
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Country | US
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Telephone | 434-260-7025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 401410767
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 0401410767
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License Number State | VA
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