Healthcare Provider Details

I. General information

NPI: 1437694635
Provider Name (Legal Business Name): NDA ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 KNIGHT LN SUITE 10
WILLISTON VT
05495-4432
US

IV. Provider business mailing address

71 KNIGHT LN SUITE 10
WILLISTON VT
05495-4432
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-7803
  • Fax:
Mailing address:
  • Phone: 802-876-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number016.0117242
License Number StateVT

VIII. Authorized Official

Name: MS. ELIZABETH D WALKER
Title or Position: PRACTICE OWNER
Credential: DMD, MSD
Phone: 802-876-7803