Provider Demographics
NPI:1760528475
Name:OCCHIETTI SELDEN DENTAL PC
Entity Type:Organization
Organization Name:OCCHIETTI SELDEN DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:OCCHIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-774-3032
Mailing Address - Street 1:225 KENT STREET
Mailing Address - Street 2:PO BOX 488
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801
Mailing Address - Country:US
Mailing Address - Phone:906-774-3032
Mailing Address - Fax:906-774-4018
Practice Address - Street 1:225 KENT STREET
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801
Practice Address - Country:US
Practice Address - Phone:906-774-3032
Practice Address - Fax:906-774-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty