Organization
STEPHEN VITAL DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN J VITAL DMD (PRESIDENT)
(480) 924-6169
Entity
Organization
Contact information
Practice address
3505 E BROWN RD, SUITE 102, MESA, AZ 85213-5508
(480) 924-6169
(480) 924-1077
Mailing address
3505 E BROWN RD, SUITE 102, MESA, AZ 85213-5508
(480) 924-6169
(480) 924-1077
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
3270
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3270
STATE OF ARIZONA
AZ
Enumeration date
05/21/2008
Last updated
05/21/2008
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