| NPI | 1114009594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ANTHONY VITULLO Member 937-426-2253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022225) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-09-10 |