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General NPI Number Information
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NPI Number | 1699001024
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Entity Type | Organization
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Legal Business Name | MAPLE VIEW ORAL AND MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 58 COURT ST
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City | MIDDLEBURY
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State | VT
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Zip | 05753-4450
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Country | US
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Telephone | 802-388-6344
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Fax | 802-388-4103
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Provider Business Mailing Address
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Address Line | 58 COURT ST
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City | MIDDLEBURY
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State | VT
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Zip | 05753-4450
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Country | US
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Telephone | 802-388-6344
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Fax | 802-388-4103
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT BOWEN
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Credential | D.M.D.,MD
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Telephone | 802-388-6344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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