Provider Demographics
NPI:1063638799
Name:VIGNAROLI, MICHELE HATT (DD,S,)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:HATT
Last Name:VIGNAROLI
Suffix:
Gender:F
Credentials:DD,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-2140
Mailing Address - Country:US
Mailing Address - Phone:925-449-6633
Mailing Address - Fax:
Practice Address - Street 1:1171 MURRIETA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4143
Practice Address - Country:US
Practice Address - Phone:925-449-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics