Healthcare Provider Details

I. General information

NPI: 1477672632
Provider Name (Legal Business Name): YOSSRI KAIRLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BIRGE ST
BRATTLEBORO VT
05301-6460
US

IV. Provider business mailing address

130 BIRGE ST
BRATTLEBORO VT
05301-6460
US

V. Phone/Fax

Practice location:
  • Phone: 802-251-1031
  • Fax: 802-251-0022
Mailing address:
  • Phone: 802-251-1031
  • Fax: 802-251-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0160002043
License Number StateVT

VIII. Authorized Official

Name: DR. YOSSRI MAHIR KAIRLIS
Title or Position: OWNER
Credential: DMD
Phone: 802-251-1031