Healthcare Provider Details

I. General information

NPI: 1386660082
Provider Name (Legal Business Name): AFFILIATES IN DENTAL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON ST
RUTLAND VT
05701-5021
US

IV. Provider business mailing address

9 WASHINGTON ST
RUTLAND VT
05701-5021
US

V. Phone/Fax

Practice location:
  • Phone: 802-773-6966
  • Fax: 802-773-6924
Mailing address:
  • Phone: 802-773-6966
  • Fax: 802-773-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateVT

VIII. Authorized Official

Name: MR. RONALD CLINTON LEWIS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 802-773-6966