| NPI | 1154534238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN P. SALEM Dentist 802-447-7147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VT 016-0001238) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |