Provider Demographics
NPI:1851517312
Name:VERMILYEA, BRUCE TODD (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:TODD
Last Name:VERMILYEA
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:PO BOX 368
Mailing Address - Street 2:175 E MILL STR
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581
Mailing Address - Country:US
Mailing Address - Phone:608-647-8868
Mailing Address - Fax:608-647-9118
Practice Address - Street 1:175 E MILL STR
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581
Practice Address - Country:US
Practice Address - Phone:608-647-8868
Practice Address - Fax:608-647-9118
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33380900Medicaid