Provider Demographics
NPI:1366755779
Name:ZAK & VITAGLIANO DENTAL PC
Entity type:Organization
Organization Name:ZAK & VITAGLIANO DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VITAGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-223-2221
Mailing Address - Street 1:6827 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3517
Mailing Address - Country:US
Mailing Address - Phone:585-223-2221
Mailing Address - Fax:
Practice Address - Street 1:6827 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3517
Practice Address - Country:US
Practice Address - Phone:585-223-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053613122300000X
NY045340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty