Provider Demographics
NPI:1932281383
Name:VITTETOE, BOB (DDS)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:VITTETOE
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 1:4558 CEDAR BRUSH
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229
Mailing Address - Country:US
Mailing Address - Phone:214-351-5179
Mailing Address - Fax:972-492-9360
Practice Address - Street 1:1809 GOLDENTRAIL CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-492-0204
Practice Address - Fax:972-492-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10085OtherBCBS
489002OtherUNITED CONCORDIA INSURANC