Provider Demographics
NPI:1952545584
Name:ARCHILLETTI, DEBORAH ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:ARCHILLETTI
Suffix:
Gender:F
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:N63 W23401 MAIN ST.
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089
Mailing Address - Country:US
Mailing Address - Phone:262-246-6806
Mailing Address - Fax:262-246-6892
Practice Address - Street 1:N63 W23401 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089
Practice Address - Country:US
Practice Address - Phone:262-246-6806
Practice Address - Fax:262-246-6892
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578625372OtherNPI # FOR TYPE 2 ENTITY