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Organization
VITAL DENTAL
Active
Organization
VITAL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZAHRA BAGHERI DMD (CEO)
(781) 535-1068
Entity
Organization
Contact information
Practice address
30 E 40TH ST RM 201, NEW YORK, NY 10016-1221
(781) 535-1068
Mailing address
180 NASSAU ST APT 8A, BROOKLYN, NY 11201-2198
(781) 535-1068
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
1223D0004X
Dental Anesthesiology
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
122400000X
Denturist
—
—
124Q00000X
Dental Hygienist
—
—
125J00000X
Dental Therapist
—
—
125K00000X
Advanced Practice Dental Therapist
—
—
126800000X
Dental Assistant
—
—
126900000X
Dental Laboratory Technician
—
—
Other
Enumeration date
09/09/2018
Last updated
09/09/2018
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