Provider Demographics
NPI:1902823792
Name:VENDETTI, CURTIS SERGIO (DMD, MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:SERGIO
Last Name:VENDETTI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 PERIMETER PKWY STE 401
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5698
Mailing Address - Country:US
Mailing Address - Phone:757-430-7690
Mailing Address - Fax:
Practice Address - Street 1:1240 PERIMETER PKWY STE 401
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-430-7690
Practice Address - Fax:757-430-7690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125871223P0106X
VA04014112751223S0112X
VA01012363222086S0122X
VA0438000214204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery