| NPI | 1629324942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED VERNON REDISKE Owner 802-254-8322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VT 016-0002226) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2012-07-24 |