Individual
VENDITA CORREIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
Mailing address
PO BOX 1440, WAUTOMA, WI 54982-1440
(920) 787-5514
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002653
WI
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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