Provider Demographics
NPI:1942328158
Name:MITTLE, VIKAS (DDS)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:MITTLE
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 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5914
Mailing Address - Country:US
Mailing Address - Phone:631-885-0515
Mailing Address - Fax:516-249-3349
Practice Address - Street 1:118 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5914
Practice Address - Country:US
Practice Address - Phone:631-885-0515
Practice Address - Fax:516-249-3349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0527721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics