Provider Demographics
NPI:1639508609
Name:VITTO DENTAL
Entity Type:Organization
Organization Name:VITTO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-505-1010
Mailing Address - Street 1:11630 OLIO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7677
Mailing Address - Country:US
Mailing Address - Phone:305-505-1010
Mailing Address - Fax:
Practice Address - Street 1:11630 OLIO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7677
Practice Address - Country:US
Practice Address - Phone:305-505-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011399A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental