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General NPI Number Information
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NPI Number | 1669868253
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Entity Type | Organization
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Legal Business Name | JORGE VITAL DDS INC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 102 E 4TH ST FL 2
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City | SANTA ANA
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State | CA
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Zip | 92701-4602
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Country | US
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Telephone | 714-558-1464
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Fax | 714-558-2971
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Provider Business Mailing Address
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Address Line | 102 E 4TH ST FL 2
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City | SANTA ANA
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State | CA
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Zip | 92701-4602
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Country | US
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Telephone | 714-558-1464
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Fax | 714-558-2971
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Authorized Official
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Title or Position | OWNER
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Name | JORGE ENRIQUE VITAL
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Credential |
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Telephone | 714-558-1464
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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 | 49701
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License Number State | CA
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