Healthcare Provider Details

I. General information

NPI: 1306106083
Provider Name (Legal Business Name): DAVID FRANCIS JETTE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MAIN ST STE 200
RICHFORD VT
05476-1153
US

IV. Provider business mailing address

44 MAIN ST STE 200
RICHFORD VT
05476-1153
US

V. Phone/Fax

Practice location:
  • Phone: 802-255-5560
  • Fax: 802-848-3859
Mailing address:
  • Phone: 802-255-5560
  • Fax: 802-848-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016.0087136
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: