Doctor Name: | TRAVIS JONATHAN VERTOLLI |
NPI Number: | 1467884395 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DMD |
License Number: | |
Business Practice Address: | Building H100 Santa Margarita Road Camp Pendleton, CA - 92055 |
Business Phone Number: | 7607258882 |
Business Fax Number: | 7607251267 |
Mailing Address: | 6 Brittany Ln, MILLVILLE |
State: | NJ |
Postal Code: | 083327261 |
Phone Number: | 8563640304 |
Fax Number: | |
NPI Enumeration Date: | 08/02/2013 |
NPI Last Update Date: | 08/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |