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General NPI Number Information
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NPI Number | 1366755779
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Entity Type | Organization
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Legal Business Name | ZAK & VITAGLIANO DENTAL PC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 6827 PITTSFORD PALMYRA RD
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City | FAIRPORT
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State | NY
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Zip | 14450-3517
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Country | US
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Telephone | 585-223-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 6827 PITTSFORD PALMYRA RD
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City | FAIRPORT
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State | NY
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Zip | 14450-3517
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Country | US
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Telephone | 585-223-2221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMANTHA A VITAGLIANO
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Credential | DDS
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Telephone | 585-223-2221
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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 | 053613
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 045340
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License Number State | NY
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