| NPI | 1851404271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM RODERICK MONTGOMERY Owner/Dentist 802-388-3553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223P0300X Dentist, Periodontics | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-01-05 |