Provider Demographics
NPI:1386656437
Name:VIVIRITO, VINCENT COSIMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:COSIMO
Last Name:VIVIRITO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 OAKTON STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018
Mailing Address - Country:US
Mailing Address - Phone:847-296-5166
Mailing Address - Fax:847-296-5186
Practice Address - Street 1:1475 OAKTON STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018
Practice Address - Country:US
Practice Address - Phone:847-296-5166
Practice Address - Fax:847-296-5186
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist