Organization
TOOTH FAIRY WORLD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYLENE VITIELLO DDS (PRESIDENT CORPORATION)
(773) 947-8884
Entity
Organization
Contact information
Practice address
1525 E 55TH STREET, #303, CHICAGO, IL 60615
(773) 947-8884
(773) 327-3331
Mailing address
1525 E 55TH STREET, #303, CHICAGO, IL 60615
(773) 947-8884
(773) 327-3331
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
IL
Other
Enumeration date
11/29/2006
Last updated
08/22/2020
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