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General NPI Number Information
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NPI Number | 1265103402
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Entity Type | Organization
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Legal Business Name | BENNINGTON ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 211 SCHOOL ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2510
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Country | US
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Telephone | 802-447-7987
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Fax | 802-447-7999
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Provider Business Mailing Address
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Address Line | 211 SCHOOL ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2510
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Country | US
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Telephone | 802-447-7987
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MICHAEL SLEEMAN
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Credential | DMD
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Telephone | 802-447-7987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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