| NPI | 1689619074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN D. SHUMAN Officer 802-863-5447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: VT 016-00981) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2009-06-03 |