Healthcare Provider Details

I. General information

NPI: 1679786842
Provider Name (Legal Business Name): ALPINE FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ROOSEVELT HWY SUITE 110
COLCHESTER VT
05446-4460
US

IV. Provider business mailing address

875 ROOSEVELT HWY SUITE 110
COLCHESTER VT
05446-4460
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-5052
  • Fax: 802-660-3991
Mailing address:
  • Phone: 802-862-5052
  • Fax: 802-660-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number016-0001072
License Number StateVT

VIII. Authorized Official

Name: DR. STEPHEN MONROE PITMON
Title or Position: OWNER
Credential: D.D.S.
Phone: 802-862-5052