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General NPI Number Information
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NPI Number | 1962772467
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Entity Type | Organization
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Legal Business Name | CHAMPLAIN SMILE SOLUTIONS, PLLC
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Dates
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Enumeration Date | 12/31/2011
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Last Update Date | 12/31/2011
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Provider Practice Location Address
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Address Line | 110 KIMBALL AVE SUITE 230
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6833
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Country | US
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Telephone | 802-864-6264
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Fax | 802-864-6402
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Provider Business Mailing Address
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Address Line | 110 KIMBALL AVE SUITE 230
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6833
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Country | US
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Telephone | 802-864-6264
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Fax | 802-864-6402
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MATTHEW DAVID GIULIANELLI
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Credential | D.M.D.
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Telephone | 802-864-6264
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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 | 016-0002257
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016-0002229
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License Number State | VT
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