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General NPI Number Information
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NPI Number | 1750568101
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Entity Type | Organization
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Legal Business Name | ORAL CARE DENTAL GROUP
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 157 RIVER ST
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City | MILTON
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State | VT
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Zip | 05468-3607
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Country | US
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Telephone | 802-893-4734
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Fax | 802-893-1406
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Provider Business Mailing Address
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Address Line | 157 RIVER ST
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City | MILTON
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State | VT
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Zip | 05468-3607
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Country | US
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Telephone | 802-893-4734
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Fax | 802-893-1406
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANGELINA SANTA MARIA
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Credential |
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Telephone | 802-893-4734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 0160002213
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License Number State | VT
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