Healthcare Provider Details

I. General information

NPI: 1689510976
Provider Name (Legal Business Name): ANNA VASSALLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N US HIGHWAY 421
CLINTON NC
28328-0410
US

IV. Provider business mailing address

9425 DELEGATES ROW
INDIANAPOLIS IN
46240-3805
US

V. Phone/Fax

Practice location:
  • Phone: 910-299-0991
  • Fax:
Mailing address:
  • Phone: 317-255-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: