Provider Demographics
NPI:1760995757
Name:VITELLI COMPREHENSIVE DENTISTRY LLC
Entity Type:Organization
Organization Name:VITELLI COMPREHENSIVE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-972-1400
Mailing Address - Street 1:19873 CENTURY BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-7144
Mailing Address - Country:US
Mailing Address - Phone:301-972-1400
Mailing Address - Fax:301-540-2132
Practice Address - Street 1:19873 CENTURY BLVD STE 230
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7144
Practice Address - Country:US
Practice Address - Phone:301-972-1400
Practice Address - Fax:301-540-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12894261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental