Healthcare Provider Details

I. General information

NPI: 1225549652
Provider Name (Legal Business Name): BARRE DENTISRY & IMPLANTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAPLE AVE
BARRE VT
05641-3424
US

IV. Provider business mailing address

20 MAPLE AVE
BARRE VT
05641-3424
US

V. Phone/Fax

Practice location:
  • Phone: 802-476-3171
  • Fax: 802-476-8788
Mailing address:
  • Phone: 802-476-3171
  • Fax: 802-476-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0002213
License Number StateVT

VIII. Authorized Official

Name: DR. AMAN U SYED
Title or Position: DENTIST
Credential: DDS
Phone: 802-476-3171