Healthcare Provider Details

I. General information

NPI: 1285700567
Provider Name (Legal Business Name): JULIE ANN SPANIEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 HINESBURG RD
SOUTH BURLINGTON VT
05403-7612
US

IV. Provider business mailing address

1050 HINESBURG RD
SOUTH BURLINGTON VT
05403-7612
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-1890
  • Fax: 802-864-7526
Mailing address:
  • Phone: 802-864-1890
  • Fax: 802-864-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1216
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: