Healthcare Provider Details

I. General information

NPI: 1740613710
Provider Name (Legal Business Name): SMART ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 TIMBER LANE
SO. BURLINGTON VT
05403
US

IV. Provider business mailing address

45 TIMBER LANE
SO. BURLINGTON VT
05403
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-3685
  • Fax: 802-862-2368
Mailing address:
  • Phone: 802-862-3685
  • Fax: 802-862-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CHRISTOPHER SMART
Title or Position: PRESIDENT
Credential: DDS, MSD
Phone: 802-862-3685