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General NPI Number Information
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NPI Number | 1811370638
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Entity Type | Organization
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Legal Business Name | MOUNT MANSFIELD DENTISTRY PLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 77 S MAIN ST SUITE 3
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City | WATERBURY
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State | VT
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Zip | 05676-1555
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Country | US
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Telephone | 802-244-6366
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Fax |
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Provider Business Mailing Address
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Address Line | 77 S MAIN ST SUITE 3
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City | WATERBURY
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State | VT
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Zip | 05676-1555
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Country | US
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Telephone | 802-244-6366
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. CYNTHIA CRITCHLOW
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Credential | CAPPM
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Telephone | 802-244-6366
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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 |
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License Number State |
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