Provider Demographics
NPI:1881883700
Name:VITAL, FELIPE DE JESUS (DDS)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:DE JESUS
Last Name:VITAL
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 1:915 PROMONTORY DR W
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7368
Mailing Address - Country:US
Mailing Address - Phone:949-673-5171
Mailing Address - Fax:714-558-3976
Practice Address - Street 1:505 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4619
Practice Address - Country:US
Practice Address - Phone:714-558-4804
Practice Address - Fax:714-558-3976
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist