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General NPI Number Information
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NPI Number | 1750887576
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Entity Type | Organization
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Legal Business Name | CHITTENDEN DENTAL
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 258 PEARL ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8573
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Country | US
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Telephone | 802-863-4146
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Fax |
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Provider Business Mailing Address
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Address Line | 258 PEARL ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8573
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Country | US
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Telephone | 802-863-4146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL MORRIS
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Credential | DDS
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Telephone | 772-418-2612
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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 | VT016.0107639
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License Number State | VT
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