Provider Demographics
NPI:1114009594
Name:RONALD A. VITULLO, DDS, LLC
Entity type:Organization
Organization Name:RONALD A. VITULLO, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VITULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-426-2253
Mailing Address - Street 1:1911 N FAIRFIELD RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2762
Mailing Address - Country:US
Mailing Address - Phone:937-426-2253
Mailing Address - Fax:937-426-7891
Practice Address - Street 1:1911 N FAIRFIELD RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2762
Practice Address - Country:US
Practice Address - Phone:937-426-2253
Practice Address - Fax:937-426-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0222251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty