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General NPI Number Information
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NPI Number | 1104465657
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Entity Type | Organization
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Legal Business Name | VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1009 S MAIN ST STE 1
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City | STOWE
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State | VT
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Zip | 05672-5275
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Country | US
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Telephone | 802-253-2761
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Fax | 802-655-9366
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Provider Business Mailing Address
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Address Line | 792 COLLEGE PKWY STE 307
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City | COLCHESTER
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State | VT
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Zip | 05446-3052
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Country | US
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Telephone | 802-655-5090
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Fax | 800-524-4660
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. KAREN DESLAURIERS
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Credential |
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Telephone | 802-655-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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