Provider Demographics
NPI:1942610365
Name:VITKUS, LAUREN E (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:VITKUS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WILLIAM ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2143
Mailing Address - Country:US
Mailing Address - Phone:315-789-2045
Mailing Address - Fax:
Practice Address - Street 1:404 WILLIAM ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2143
Practice Address - Country:US
Practice Address - Phone:315-789-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0585511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics