Individual
BOB VITTETOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1809 GOLDENTRAIL CT, SUITE 100, CARROLLTON, TX 75010
(972) 492-0204
(972) 492-9360
Mailing address
4558 CEDAR BRUSH, DALLAS, TX 75229
(214) 351-5179
(972) 492-9360
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10085
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
489002
UNITED CONCORDIA INSURANC
—
01
—
D10085
BCBS
—
Enumeration date
10/19/2006
Last updated
07/08/2007
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