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General NPI Number Information
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NPI Number | 1366901464
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Entity Type | Organization
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Legal Business Name | WINDHAM COUNTY DENTAL CENTER INC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 375 CANAL ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-6936
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Country | US
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Telephone | 802-490-2923
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Fax | 802-246-1459
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Provider Business Mailing Address
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Address Line | 375 CANAL STREET
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City | BRATTLEBORO
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State | VT
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Zip | 05301
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Country | US
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Telephone | 802-490-2923
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Fax | 802-246-1459
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CARMEN J. DERBY
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Credential |
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Telephone | 802-490-2923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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