Healthcare Provider Details

I. General information

NPI: 1275574675
Provider Name (Legal Business Name): NORTHFIELD DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 S MAIN ST
NORTHFIELD VT
05663-5745
US

IV. Provider business mailing address

391 S MAIN ST
NORTHFIELD VT
05663-5745
US

V. Phone/Fax

Practice location:
  • Phone: 802-485-3051
  • Fax: 802-485-8384
Mailing address:
  • Phone: 802-485-3051
  • Fax: 802-485-8384

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: LISA DILENA
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 802-485-3051