Provider Demographics
NPI:1669412557
Name:VITAGLIANO, SAMANTHA A (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:A
Last Name:VITAGLIANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 PITTSFORD PALMYRA ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-223-2221
Mailing Address - Fax:585-223-2308
Practice Address - Street 1:6827 PITTSFORD PALMYRA ROAD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-223-2221
Practice Address - Fax:585-223-2308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0453401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7037OtherEXCELLUS BCBS ROCHESTER
629880OtherUNITED CONCORDIA