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General NPI Number Information
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NPI Number | 1386016970
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Entity Type | Organization
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Legal Business Name | JUST KIDS PEDIATRIC DENTISTRY, PLC
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 303 ROUTE 5 S UNIT 2
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City | NORWICH
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State | VT
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Zip | 05055-9466
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Country | US
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Telephone | 802-649-5210
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Fax | 802-649-7284
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Provider Business Mailing Address
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Address Line | 303 ROUTE 5 S UNIT 2
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City | NORWICH
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State | VT
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Zip | 05055-9466
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Country | US
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Telephone | 802-649-5210
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Fax | 802-649-7284
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. STEVEN K RAYES
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Credential | DDS, MS
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Telephone | 802-649-5210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 016.0111094
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License Number State | VT
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