Provider Demographics
NPI:1710754452
Name:VITA DENTAL LLC
Entity Type:Organization
Organization Name:VITA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-582-8718
Mailing Address - Street 1:420 NW 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1618
Mailing Address - Country:US
Mailing Address - Phone:954-583-1514
Mailing Address - Fax:
Practice Address - Street 1:420 NW 74TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1618
Practice Address - Country:US
Practice Address - Phone:954-583-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental