Provider Demographics
NPI:1710078167
Name:VITO, MICHAEL J (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:VITO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 THOMAS INDIAN SCHOOL DR
Mailing Address - Street 2:CATTARAUGUS INDIAN RESERVATION HEALTH CENTER
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9300
Mailing Address - Country:US
Mailing Address - Phone:716-532-5582
Mailing Address - Fax:716-532-1428
Practice Address - Street 1:36 THOMAS INDIAN SCHOOL DR
Practice Address - Street 2:CATTARAUGUS INDIAN RESERVATION HEALTH CENTER
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9300
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:716-532-1428
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0530321223G0001X
CA581641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice