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General NPI Number Information
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NPI Number | 1760995757
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Entity Type | Organization
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Legal Business Name | VITELLI COMPREHENSIVE DENTISTRY LLC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 11/13/2017
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Provider Practice Location Address
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Address Line | 19873 CENTURY BLVD STE 230
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City | GERMANTOWN
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State | MD
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Zip | 20874-7144
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Country | US
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Telephone | 301-972-1400
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Fax | 301-540-2132
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Provider Business Mailing Address
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Address Line | 19873 CENTURY BLVD STE 230
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City | GERMANTOWN
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State | MD
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Zip | 20874-7144
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Country | US
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Telephone | 301-972-1400
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Fax | 301-540-2132
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBBIE B THORPE
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Credential |
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Telephone | 301-972-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12894
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License Number State | MD
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