Provider Demographics
NPI:1992088470
Name:VITOUS, NELSON FRANK (DDS)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:FRANK
Last Name:VITOUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:F
Other - Last Name:VITOUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:509 OLIVE WAY
Mailing Address - Street 2:SUITE 836
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1769
Mailing Address - Country:US
Mailing Address - Phone:206-623-5815
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 836
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1769
Practice Address - Country:US
Practice Address - Phone:206-623-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist