Provider Demographics
NPI:1487844577
Name:VITARELLI, ANTHONY PIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PIO
Last Name:VITARELLI
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 1:2075 FOREST AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4812
Mailing Address - Country:US
Mailing Address - Phone:408-287-3892
Mailing Address - Fax:408-293-7765
Practice Address - Street 1:2075 FOREST AVE STE 6
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4812
Practice Address - Country:US
Practice Address - Phone:408-287-3892
Practice Address - Fax:408-293-7765
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice