Provider Demographics
NPI:1528359395
Name:VITAGLIANO, CHRISTOPHER GENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GENE
Last Name:VITAGLIANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 E SAHUARO DR
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6722
Mailing Address - Country:US
Mailing Address - Phone:480-443-3339
Mailing Address - Fax:
Practice Address - Street 1:6945 E SAHUARO DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6722
Practice Address - Country:US
Practice Address - Phone:480-443-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD008409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program