Provider Demographics
NPI:1053301762
Name:VITTORIA, NICK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:J
Last Name:VITTORIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ELDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3433
Mailing Address - Country:US
Mailing Address - Phone:631-862-2260
Mailing Address - Fax:
Practice Address - Street 1:859 CONNETQUOT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1400
Practice Address - Country:US
Practice Address - Phone:631-277-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0393941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice