| NPI | 1104100841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER J CARMACK Owner 802-442-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 0160073365) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2018-03-17 |