MEDICARE: DR. CHRIS MICHAEL VITAKES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	032775	CA

General Provider Information

NPI Number	:	1528288115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS MICHAEL VITAKES D.D.S.

Provider Business Mailing Address
First Line	:	909 SAN RAMON VALLEY BLVD STE 218
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4038
Country	:	US
Telephone Number	:	925-553-7761
Fax Number	:	925-553-7855

Provider Business Practice Location Address
First Line	:	909 SAN RAMON VALLEY BLVD STE 218
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4038
Country	:	US
Telephone Number	:	510-825-9105
Fax Number	:	925-553-7855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/02/2021

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Directions to “ DR. CHRIS MICHAEL VITAKES D.D.S.” Practice Location

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