Provider Demographics
NPI:1508051210
Name:VITAL DENT DENTISTRY
Entity Type:Organization
Organization Name:VITAL DENT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-457-7722
Mailing Address - Street 1:555 WASHINGTON AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6607
Mailing Address - Country:US
Mailing Address - Phone:305-604-5707
Mailing Address - Fax:
Practice Address - Street 1:555 WASHINGTON AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6607
Practice Address - Country:US
Practice Address - Phone:305-604-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty