| NPI | 1861970006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER J CARMACK Owner/Operator 802-442-9500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VT 0160073365) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2018-07-31 |