| NPI | 1417408717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JUSTIN CARMACK Owner 802-773-1020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VT 0160073365) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2018-02-23 |