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General NPI Number Information
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NPI Number | 1508536160
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN ENDODONTICS, PLLC
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 227 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1411
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Country | US
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Telephone | 802-864-0461
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Fax |
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Provider Business Mailing Address
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Address Line | 227 COLCHESTER AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-1411
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Country | US
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Telephone | 802-864-0461
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC JUDD FEUER
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Credential | DMD
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Telephone | 412-512-8458
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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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