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General NPI Number Information
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NPI Number | 1861690075
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Entity Type | Organization
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Legal Business Name | PAUL G. BOERMAN, PC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 44 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7204
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Country | US
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Telephone | 802-860-6725
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Fax | 802-864-0277
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Provider Business Mailing Address
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Address Line | 44 TIMBER LN
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-7204
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Country | US
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Telephone | 802-860-6725
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Fax | 802-864-0277
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL G. BOERMAN
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Credential | DDS
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Telephone | 802-860-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0160000990
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License Number State | VT
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