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General NPI Number Information
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NPI Number | 1104081520
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Entity Type | Individual
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Provider Name | LORI VESPIA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 238 SOLANA RD
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City | PONTE VEDRA
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State | FL
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Zip | 32082-2297
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Country | US
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Telephone | 904-280-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 13 ORCHARDVIEW DR
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City | SEWELL
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State | NJ
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Zip | 08080-3537
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Country | US
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Telephone | 856-340-8942
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN20010
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI1017909
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS027742L
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License Number State | PA
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