Healthcare Provider Details

I. General information

NPI: 1669547576
Provider Name (Legal Business Name): DENNIS E. LEBLANC, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MAIN ST.
DERBY VT
05829
US

IV. Provider business mailing address

296 MAIN ST.
DERBY VT
05829
US

V. Phone/Fax

Practice location:
  • Phone: 802-766-4711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number687
License Number StateVT

VIII. Authorized Official

Name: CYNTHIA LEBLANC
Title or Position: OFFICE MANAGER
Credential:
Phone: 802-766-4711