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General NPI Number Information
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NPI Number | 1194278499
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Entity Type | Organization
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Legal Business Name | HUBBARD PARK FAMILY DENTISTRY, PLLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 174 ELM ST
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City | MONTPELIER
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State | VT
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Zip | 05602-2262
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Country | US
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Telephone | 802-229-9494
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Fax | 802-229-4515
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Provider Business Mailing Address
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Address Line | 174 ELM ST
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City | MONTPELIER
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State | VT
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Zip | 05602-2262
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Country | US
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Telephone | 802-229-9494
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Fax | 802-229-4515
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | CAROLINE MARISA MURPHY
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Credential | DDS
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Telephone | 802-229-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016000292
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License Number State | VT
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