| NPI | 1326139130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY WATSON Administrator 802-264-6909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| 1223P0300X Dentist Periodontics | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |