Healthcare Provider Details

I. General information

NPI: 1356267710
Provider Name (Legal Business Name): TOJO JOSEPH VETTUKALLEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 WATERLOO AVE
WEST SALEM WI
54669-9270
US

IV. Provider business mailing address

3081 BERLIN DR APT 318
ONALASKA WI
54650-2216
US

V. Phone/Fax

Practice location:
  • Phone: 608-659-6204
  • Fax:
Mailing address:
  • Phone: 559-321-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002257-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: