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General NPI Number Information
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NPI Number | 1437694635
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Entity Type | Organization
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Legal Business Name | NDA ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/23/2016
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Last Update Date | 12/23/2016
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Provider Practice Location Address
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Address Line | 71 KNIGHT LN SUITE 10
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City | WILLISTON
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State | VT
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Zip | 05495-4432
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Country | US
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Telephone | 802-876-7803
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Fax |
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Provider Business Mailing Address
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Address Line | 71 KNIGHT LN SUITE 10
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City | WILLISTON
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State | VT
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Zip | 05495-4432
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Country | US
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Telephone | 802-876-7803
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MS. ELIZABETH D WALKER
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Credential | DMD, MSD
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Telephone | 802-876-7803
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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 | 016.0117242
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License Number State | VT
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