Provider Demographics
NPI:1750496931
Name:VETTER, MARY ANN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:VETTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 STATE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4650
Mailing Address - Country:US
Mailing Address - Phone:360-459-2677
Mailing Address - Fax:360-528-8709
Practice Address - Street 1:1808 STATE AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4650
Practice Address - Country:US
Practice Address - Phone:360-459-2677
Practice Address - Fax:360-528-8709
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE73211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BI3940322OtherDEA