Provider Demographics
NPI:1578625372
Name:DEBORAH A ARCHILLETTI DDS SC
Entity Type:Organization
Organization Name:DEBORAH A ARCHILLETTI DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARCHILLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-246-8810
Mailing Address - Street 1:N63 W23401 MAIN ST.
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089
Mailing Address - Country:US
Mailing Address - Phone:262-246-6806
Mailing Address - Fax:262-246-6892
Practice Address - Street 1:N63 W23401 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089
Practice Address - Country:US
Practice Address - Phone:262-246-6806
Practice Address - Fax:262-246-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty