Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 12587 | MD |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401411275 | VA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0438000214 | VA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 0101236322 | VA |
NPI | 1902823792 |
---|---|
Provider Name | Curtis Sergio Vendetti |
First Address | Virginia Beach, VA 23454-5698 |
Second Address | Virginia Beach, VA 23454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 23/05/2018 |