| NPI | 1922841329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DAVIS Doctor/Owner 802-373-4990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |