Provider Demographics
NPI:1003449216
Name:DEBITETTO, VINCENT MICHAEL
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MICHAEL
Last Name:DEBITETTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOUNDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1526
Mailing Address - Country:US
Mailing Address - Phone:914-473-0600
Mailing Address - Fax:
Practice Address - Street 1:18-00 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2330
Practice Address - Country:US
Practice Address - Phone:551-286-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT139231223S0112X
NJ22DI030285001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery