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General NPI Number Information
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NPI Number | 1588849004
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Entity Type | Individual
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Provider Name | MARGARET NASSYM JANISSE DMD
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Gender | Female
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 217 MAXHAM MEADOW WAY # 10 SUITE 104C
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City | WOODSTOCK
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State | VT
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Zip | 05091-1162
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Country | US
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Telephone | 802-457-1903
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Fax |
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Provider Business Mailing Address
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Address Line | 217 MAXHAM MEADOW WAY # 10 SUITE 104C
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City | WOODSTOCK
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State | VT
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Zip | 05091-1162
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Country | US
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Telephone | 802-457-1903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016-0002248
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License Number State | VT
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