Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS037946 | PA |
NPI | 1104087535 |
---|---|
Provider Name | Dr. Melissa Vettraino |
First Address | Philadelphia, PA 19145-4638 |
Second Address | Philadelphia, PA 19145-4638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 15/05/2012 |