| NPI | 1285127621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID L STANLEY Owner 802-524-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2018-06-11 |