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General NPI Number Information
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NPI Number | 1053937292
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Entity Type | Organization
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Legal Business Name | MIDDLEBURY PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 132 S VILLAGE GRN
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City | MIDDLEBURY
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State | VT
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Zip | 05753-6900
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Country | US
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Telephone | 802-388-0909
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Fax | 802-989-7095
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Provider Business Mailing Address
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Address Line | 132 S VILLAGE GRN
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City | MIDDLEBURY
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State | VT
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Zip | 05753-6900
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Country | US
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Telephone | 802-388-0909
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Fax | 802-989-7095
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Authorized Official
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Title or Position | OWNER / MEMBER
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Name | DR. BRIAN D COLLINS
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Credential | DDS
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Telephone | 802-388-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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