| NPI | 1104465657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN DESLAURIERS Billing Manager 802-655-5090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2024-04-09 |