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General NPI Number Information
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NPI Number | 1154958213
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Entity Type | Individual
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Provider Name | COLLIN KWASNIK DDS
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 395 PAINE TPKE N
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City | BERLIN
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State | VT
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Zip | 05602-9157
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Country | US
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Telephone | 802-229-0561
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 COX BROOK RD
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City | NORTHFIELD
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State | VT
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Zip | 05663-6614
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Country | US
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Telephone | 802-272-4498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016.0133962
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License Number State | VT
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