| NPI | 1992878367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY KATZ EVERHART Provider Owner 802-862-6562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 0160001236) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 0160000800) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2020-08-22 |