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General NPI Number Information
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NPI Number | 1689619074
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN PERIODONTICS, PLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 247 PEARL ST SUITE 2
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City | BURLINGTON
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State | VT
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Zip | 05401-8572
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Country | US
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Telephone | 802-863-5447
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Fax |
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Provider Business Mailing Address
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Address Line | 247 PEARL ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8572
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Country | US
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Telephone | 802-863-5447
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. BRIAN D. SHUMAN
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Credential | DMD
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Telephone | 802-863-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 016-00981
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License Number State | VT
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