Provider Demographics
NPI:1386780658
Name:ZELLI, MARY DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:DIANE
Last Name:ZELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1420 CENTRAL PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4932
Mailing Address - Country:US
Mailing Address - Phone:540-786-0696
Mailing Address - Fax:540-785-1340
Practice Address - Street 1:1420 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4932
Practice Address - Country:US
Practice Address - Phone:540-786-0696
Practice Address - Fax:540-785-1340
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010069411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics