Mary Vezzetti, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5042-015 Issued in WI

Practice address

W249N5245 Executive Dr
Suite 206
Sussex, WI 53089-4393

Phone

(262) 820-3330

Fax

(262) 820-3325

NPI assigned

Sep 18, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1306095922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W249N5245 EXECUTIVE DR",
            "address_2": "SUITE 206",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530894393",
            "telephone_number": "262-820-3330",
            "fax_number": "262-820-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W249N5245 EXECUTIVE DR",
            "address_2": "SUITE 206",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530894393",
            "telephone_number": "262-820-3330",
            "fax_number": "262-820-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VEZZETTI",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5042-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Tsiampas
• Victoria Lynn Tyra, RN, FNP-C
• Bradley A Tythcott, PT
• Rick L. Vaniperen, R.PH , M.B.A
• Vezzetti Family Dental Care
• Village of Lisbon
• Village of Sussex
• Kirsten Marie Virnig, LMT
• Quynh Vo, PHARM.D
• Linda S Vogel, P.A

• General Practice Dentistry in Sussex, WI
• Providers in Sussex, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.