Provider Demographics
NPI:1720712938
Name:C.W. VITTITOW DMD PLLC
Entity Type:Organization
Organization Name:C.W. VITTITOW DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:VITTITOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-523-3514
Mailing Address - Street 1:2520 VALLETTE STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:502-523-3514
Mailing Address - Fax:
Practice Address - Street 1:2219 RIMLAND DR STE 110
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8661
Practice Address - Country:US
Practice Address - Phone:360-543-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies