Provider Demographics
NPI:1043285562
Name:VAITIEKAITIS, ARUNAS S (DDS)
Entity type:Individual
Prefix:DR
First Name:ARUNAS
Middle Name:S
Last Name:VAITIEKAITIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2995989Medicaid
MI4060802Medicaid
MIU21883Medicare UPIN
MI4060802Medicaid