Healthcare Provider Details

I. General information

NPI: 1932231453
Provider Name (Legal Business Name): EDWARD W KENTISH LIC. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 E STATE ST
MONTPELIER VT
05602-3087
US

IV. Provider business mailing address

1068 W COUNTY RD
CALAIS VT
05648-7575
US

V. Phone/Fax

Practice location:
  • Phone: 802-229-4537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000114
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: