Provider Demographics
NPI:1972867968
Name:VEZZETTI FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:VEZZETTI FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:VEZZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-820-3330
Mailing Address - Street 1:W249N5245 EXECUTIVE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-4393
Mailing Address - Country:US
Mailing Address - Phone:262-820-3330
Mailing Address - Fax:
Practice Address - Street 1:W249N5245 EXECUTIVE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-4393
Practice Address - Country:US
Practice Address - Phone:262-820-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI504215261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental