Provider Demographics
NPI:1770641151
Name:VITALIE, WILLIAM A (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:VITALIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CHURCH ST
Mailing Address - Street 2:SUITE #300 WEST
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2788
Mailing Address - Country:US
Mailing Address - Phone:724-349-8380
Mailing Address - Fax:724-349-3702
Practice Address - Street 1:655 CHURCH ST
Practice Address - Street 2:SUITE #300 WEST
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2788
Practice Address - Country:US
Practice Address - Phone:724-349-8380
Practice Address - Fax:724-349-3702
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022308-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice