Provider Demographics
NPI:1467608182
Name:VITO W. CIARAVINO D.D.S. P.C.
Entity Type:Organization
Organization Name:VITO W. CIARAVINO D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIARAVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-885-5150
Mailing Address - Street 1:20840 VERNIER RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1479
Mailing Address - Country:US
Mailing Address - Phone:313-885-5150
Mailing Address - Fax:313-886-2040
Practice Address - Street 1:20840 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1479
Practice Address - Country:US
Practice Address - Phone:313-885-5150
Practice Address - Fax:313-886-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI161011223G0001X
MI161081223G0001X
MI674301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty