Organization
TOOTH FAIRY WORLD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYLENE VITIELLO DDS DENTIST (PRESIDENT OF CORPORATION)
(773) 327-3331
Entity
Organization
Contact information
Practice address
2069 NORTH CLYBOURN AVENUE, CHICAGO, IL 60614
(773) 327-3331
(773) 868-6453
Mailing address
2069 N CLYBOURN AVE, CHICAGO, IL 60614
(773) 327-3331
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
IL
Other
Enumeration date
12/04/2006
Last updated
08/22/2020
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