# TOOTH FAIRY WORLD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811055072
- **Authorized official:** MARYLENE VITIELLO DDS DENTIST (PRESIDENT OF CORPORATION)
- **Authorized official phone:** (773) 327-3331

## Contact information

- **Practice address:** 2069 NORTH CLYBOURN AVENUE, CHICAGO, IL 60614
- **Practice address phone:** (773) 327-3331
- **Practice address fax:** (773) 868-6453
- **Mailing address:** 2069 N CLYBOURN AVE, CHICAGO, IL 60614
- **Mailing address phone:** (773) 327-3331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | IL | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 08/22/2020