Healthcare Provider Details

I. General information

NPI: 1922120484
Provider Name (Legal Business Name): BARTON STREET DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BARTON STREET SUITE 2
BRADFORD VT
05033
US

IV. Provider business mailing address

21 BARTON STREET SUITE 2
BRADFORD VT
05033
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-5776
  • Fax:
Mailing address:
  • Phone: 802-222-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1214
License Number StateVT

VIII. Authorized Official

Name: DR. CHARLES BARTON II
Title or Position: SECRETARY
Credential: DMD
Phone: 802-222-5776