Healthcare Provider Details

I. General information

NPI: 1295803005
Provider Name (Legal Business Name): BENTLEY A. MERRICK, D.M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 HINESBURG RD
SOUTH BURLINGTON VT
05403-7621
US

IV. Provider business mailing address

1050 HINESBURG ROAD P.O. BOX 2225
SOUTH BURLINGTON VT
05407-2225
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-3827
  • Fax: 802-859-0912
Mailing address:
  • Phone: 802-864-3827
  • Fax: 802-859-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number016-0001194
License Number StateVT

VIII. Authorized Official

Name: DR. BENTLEY ATWOOD HOWE MERRICK
Title or Position: PRESIDENT
Credential: DMD
Phone: 802-864-3827