NPI 1619134079

Stephen Vital DMD INC

Organisation Preferred Provider Organization Mesa, AZ

Practice location

Address: 3505 E Brown Rd Suite 102, Mesa, AZ 85213-5508
Phone: (480) 924-6169
Fax: (480) 924-1077

Authorised official

Name: Stephen J Vital
Title: President
Phone: (480) 924-6169

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 3270 (AZ)

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Registry record

NPI: 1619134079
Entity type: Organization
NPI issued: 21 May 2008
Record last updated: 21 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.