1811998669 NPI number — MARY ELIZABETH VENDETTI D.M.D.

Table of content: MARY ELIZABETH VENDETTI D.M.D. (NPI 1811998669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811998669 NPI number — MARY ELIZABETH VENDETTI D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VENDETTI
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VENDETTI
Provider Other First Name:
MOLLY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1811998669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2453 OAKMONT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-6460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-485-1131
Provider Business Mailing Address Fax Number:
541-485-0785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2453 OAKMONT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-6460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-485-1131
Provider Business Practice Location Address Fax Number:
541-485-0785
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D7222 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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