Provider Demographics
NPI:1275618019
Name:VITKUS AND SCUTARI DDS, PC
Entity Type:Organization
Organization Name:VITKUS AND SCUTARI DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUTARI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-637-4476
Mailing Address - Street 1:516 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1537
Mailing Address - Country:US
Mailing Address - Phone:315-637-4476
Mailing Address - Fax:315-637-1261
Practice Address - Street 1:516 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1537
Practice Address - Country:US
Practice Address - Phone:315-637-4476
Practice Address - Fax:315-637-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045842-11223S0112X
NY034071-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty