Basic Information
| Provider Information | |||||||||
| NPI: | 1699751115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRATTALI | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D. D. S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 357 | ||||||||
| Address2: | |||||||||
| City: | WELLPINIT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990400357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092584517 | ||||||||
| FaxNumber: | 5092584456 | ||||||||
| Practice Location | |||||||||
| Address1: | 6203 AGENCY LOOP RD | ||||||||
| Address2: | |||||||||
| City: | WELLPINIT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990400357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092584517 | ||||||||
| FaxNumber: | 5092584456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 07883 | MD | Y | Dental Providers | Dentist | General Practice |
No ID Information.