Provider Demographics
NPI:1700150299
Name:SCHWIETERMAN, VANESSA R (RDH, BAS)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:R
Last Name:SCHWIETERMAN
Suffix:
Gender:F
Credentials:RDH, BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12175 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-8814
Mailing Address - Country:US
Mailing Address - Phone:941-323-9569
Mailing Address - Fax:
Practice Address - Street 1:1830 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3112
Practice Address - Country:US
Practice Address - Phone:941-366-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 15983124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist