Healthcare Provider Details

I. General information

NPI: 1144366774
Provider Name (Legal Business Name): ALDERBROOK DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ESSEX WAY SUITE 100
ESSEX JUNCTION VT
05452-3425
US

IV. Provider business mailing address

8 ESSEX WAY SUITE 100
ESSEX JUNCTION VT
05452-3425
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-1233
  • Fax: 802-879-3181
Mailing address:
  • Phone: 802-879-1233
  • Fax: 802-879-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LUCINDA MARIE BELLINO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 802-879-1233