| NPI | 1700327673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER PETRY Director Of Practice Administration 802-430-7254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0000905) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |