Healthcare Provider Details

I. General information

NPI: 1801839014
Provider Name (Legal Business Name): PROFESSIONAL DENTAL CARE, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HIGH STREET
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

72 HIGH STREET
BRATTLEBORO VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-9644
  • Fax: 802-257-8512
Mailing address:
  • Phone: 802-254-9644
  • Fax: 802-257-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0160000888
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0160001173
License Number StateVT

VIII. Authorized Official

Name: DR. LEONARD GIORDANO JR.
Title or Position: PARTNER
Credential: DMD
Phone: 732-492-2440