| NPI | 1033562715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONI GOLDEN Owner 802-878-1170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 0160088849) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 0160120271) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |