Provider Demographics
NPI:1134234826
Name:VAITAS, RIMANTAS O (DDS)
Entity type:Individual
Prefix:DR
First Name:RIMANTAS
Middle Name:O
Last Name:VAITAS
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 1:120 S MAIN ST
Mailing Address - Street 2:STE. E
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1975
Mailing Address - Country:US
Mailing Address - Phone:248-684-2280
Mailing Address - Fax:248-684-7806
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:STE. E
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1975
Practice Address - Country:US
Practice Address - Phone:248-684-2280
Practice Address - Fax:248-684-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X
MI29010149281223G0001X
MIL551022124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No126800000XDental ProvidersDental Assistant
No124Q00000XDental ProvidersDental Hygienist