Provider Demographics
NPI:1376773895
Name:VITAL, DANAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANAE
Middle Name:
Last Name:VITAL
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 1:8910 NW 162ND TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6108
Mailing Address - Country:US
Mailing Address - Phone:305-819-7398
Mailing Address - Fax:
Practice Address - Street 1:1250 SW 27TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4748
Practice Address - Country:US
Practice Address - Phone:305-649-2231
Practice Address - Fax:305-541-0253
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist