Provider Demographics
NPI:1558306415
Name:MARK A VITALE DMD & PAUL M TEDESCHI DMD PA
Entity Type:Organization
Organization Name:MARK A VITALE DMD & PAUL M TEDESCHI DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-494-7575
Mailing Address - Street 1:69 STATE HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-494-7575
Mailing Address - Fax:732-494-4105
Practice Address - Street 1:69 STATE HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-494-7575
Practice Address - Fax:732-494-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ220I01414100122300000X
NJ220I01684700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty