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General NPI Number Information
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NPI Number | 1326500141
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN DENTAL SLEEP CENTER
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 206 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-2411
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Country | US
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Telephone | 802-775-2218
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Fax | 844-929-1134
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Provider Business Mailing Address
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Address Line | 204 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-2411
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Country | US
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Telephone | 802-775-5286
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Fax | 802-747-0056
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JUDITH M FISCH
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Credential | DDS
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Telephone | 28-775-2218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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