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General NPI Number Information
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NPI Number | 1326139130
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Entity Type | Organization
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Legal Business Name | TIMBERLANE DENTAL GROUP
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 60 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7204
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Country | US
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Telephone | 802-264-6909
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Fax | 802-862-8942
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Provider Business Mailing Address
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Address Line | 60 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7204
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Country | US
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Telephone | 802-264-6909
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Fax | 802-862-8942
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DOROTHY WATSON
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Credential |
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Telephone | 802-264-6909
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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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 | 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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Taxonomy #4
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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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