Provider Demographics
NPI:1427321694
Name:MARCHETTO, JOHN J (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MARCHETTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TOWN CENTER BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3641
Mailing Address - Country:US
Mailing Address - Phone:954-389-1002
Mailing Address - Fax:954-384-4876
Practice Address - Street 1:1600 TOWN CENTER BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-1002
Practice Address - Fax:954-384-4876
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics