Provider Demographics
NPI:1801976980
Name:VITALE, ANTHONY JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:VITALE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PERRINE RD
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2843
Mailing Address - Country:US
Mailing Address - Phone:732-727-1211
Mailing Address - Fax:732-727-0880
Practice Address - Street 1:400 PERRINE RD
Practice Address - Street 2:SUITE 400A
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2843
Practice Address - Country:US
Practice Address - Phone:732-727-1211
Practice Address - Fax:732-727-0880
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013722001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice