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General NPI Number Information
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NPI Number | 1164073136
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Entity Type | Organization
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Legal Business Name | LYNN H. DUBOFF, DMD, PLLC
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Dates
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Enumeration Date | 09/21/2019
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Last Update Date | 09/21/2019
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Provider Practice Location Address
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Address Line | 72 ALLEN ST
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City | RUTLAND
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State | VT
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Zip | 05701-4568
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Country | US
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Telephone | 802-779-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 237 HAWLEY LN
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City | RUTLAND
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State | VT
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Zip | 05701-8979
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Country | US
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Telephone | 802-855-8771
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. LYNN HARASTY DUBOFF
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Credential | DMD
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Telephone | 802-779-6137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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