MEDICARE: DR. LORI VESPIA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN20010	FL
2	1223G0001X	General Practice Dentistry	DI1017909	NJ
3	122300000X	Dentist	DS027742L	PA

General Provider Information

NPI Number	:	1104081520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI VESPIA D.M.D.

Provider Business Mailing Address
First Line	:	13 ORCHARDVIEW DR
Second Line	:
City	:	SEWELL
State	:	NJ
Zip	:	08080-3537
Country	:	US
Telephone Number	:	856-340-8942
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 SOLANA RD
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-2297
Country	:	US
Telephone Number	:	904-280-1717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	11/13/2020

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