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General NPI Number Information
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NPI Number | 1881883700
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Entity Type | Individual
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Provider Name | FELIPE DE JESUS VITAL DDS.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 505 N MAIN ST FL 2
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City | SANTA ANA
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State | CA
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Zip | 92701-4619
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Country | US
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Telephone | 714-558-4804
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Fax | 714-558-3976
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Provider Business Mailing Address
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Address Line | 915 PROMONTORY DR W
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7368
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Country | US
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Telephone | 949-673-5171
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Fax | 714-558-3976
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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 | 53428
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License Number State | CA
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