Provider Demographics
NPI:1902871767
Name:ARUNAS S VAITIEKAITIS DDS PC
Entity Type:Organization
Organization Name:ARUNAS S VAITIEKAITIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUNAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAITIEKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-984-8281
Mailing Address - Street 1:805 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3745
Mailing Address - Country:US
Mailing Address - Phone:810-984-8281
Mailing Address - Fax:
Practice Address - Street 1:805 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3745
Practice Address - Country:US
Practice Address - Phone:810-984-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2995989Medicaid
MI4060802Medicaid
MI5746483OtherBC/BS
MI5746483Medicare ID - Type Unspecified
MI2995989Medicaid