Provider Demographics
NPI:1003560137
Name:VINTURELLA, BROOKE VIRGINIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:VIRGINIA
Last Name:VINTURELLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 TOPGOLF WAY APT 4304
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0333
Mailing Address - Country:US
Mailing Address - Phone:985-299-7572
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST # GC5110
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:919-457-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7337390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program