Provider Demographics
NPI:1255857942
Name:EMILY VACCAREZZA, DDS, INC
Entity Type:Organization
Organization Name:EMILY VACCAREZZA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VACCAREZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-815-5244
Mailing Address - Street 1:2774 WORDEN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5704
Mailing Address - Country:US
Mailing Address - Phone:209-815-5244
Mailing Address - Fax:
Practice Address - Street 1:2446 FENTON ST STE 102
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3516
Practice Address - Country:US
Practice Address - Phone:619-216-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty