Provider Demographics
NPI:1891910451
Name:VINCENT ZAMMUTO DDS LTD
Entity Type:Organization
Organization Name:VINCENT ZAMMUTO DDS LTD
Other - Org Name:MULFORD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMMUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-877-6453
Mailing Address - Street 1:4001 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-6949
Mailing Address - Country:US
Mailing Address - Phone:815-877-6453
Mailing Address - Fax:815-637-4295
Practice Address - Street 1:4001 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-6949
Practice Address - Country:US
Practice Address - Phone:815-877-6453
Practice Address - Fax:815-637-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty