Provider Demographics
NPI:1861507469
Name:VITTORI, MARK RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:VITTORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 ARMOUR CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1464
Mailing Address - Country:US
Mailing Address - Phone:630-961-2479
Mailing Address - Fax:
Practice Address - Street 1:1145 WESTGATE ST
Practice Address - Street 2:STE 205
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1089
Practice Address - Country:US
Practice Address - Phone:708-383-2120
Practice Address - Fax:708-383-4913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice