| NPI | 1235572918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA MELVIN Practice Manager 802-622-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VT 016.0002059) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2014-02-03 |