Provider Demographics
NPI:1942423280
Name:VITALE, JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:
Last Name:VITALE
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 1:16235 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2736
Mailing Address - Country:US
Mailing Address - Phone:561-637-4443
Mailing Address - Fax:561-637-4428
Practice Address - Street 1:16235 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2736
Practice Address - Country:US
Practice Address - Phone:561-637-4443
Practice Address - Fax:561-637-4428
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0433981223G0001X
FLDN139751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice