| NPI | 1083850374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEDIDIAH L JANISSE President 802-457-1903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016-0002247) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2019-10-11 |