Provider Demographics
NPI:1316794951
Name:VITALITY DENTAL, LLC
Entity type:Organization
Organization Name:VITALITY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-221-2621
Mailing Address - Street 1:1401 AIRPORT PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1524
Mailing Address - Country:US
Mailing Address - Phone:307-221-2621
Mailing Address - Fax:
Practice Address - Street 1:1401 AIRPORT PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1524
Practice Address - Country:US
Practice Address - Phone:307-221-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental