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General NPI Number Information
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NPI Number | 1760528475
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Entity Type | Organization
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Legal Business Name | OCCHIETTI SELDEN DENTAL PC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 225 KENT STREET
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801
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Country | US
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Telephone | 906-774-3032
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Fax | 906-774-4018
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Provider Business Mailing Address
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Address Line | 225 KENT STREET PO BOX 488
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801
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Country | US
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Telephone | 906-774-3032
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Fax | 906-774-4018
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANTHONY JOSEPH OCCHIETTI
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Credential | DDS
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Telephone | 906-774-3032
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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 | 015830
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License Number State | MI
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