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General NPI Number Information
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NPI Number | 1982104675
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Entity Type | Organization
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Legal Business Name | THE DENTISTS ON PEARL
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 49 PEARL ST
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City | ESSEX JUNCTION
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State | VT
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Zip | 05452-3622
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Country | US
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Telephone | 802-878-4631
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Fax | 802-878-8481
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Provider Business Mailing Address
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Address Line | 313 S BAY CIR
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City | COLCHESTER
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State | VT
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Zip | 05446-3890
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Country | US
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Telephone | 802-309-4431
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SARAH EVANS
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Credential | DDS
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Telephone | 802-309-4431
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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 | 016.0094121
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License Number State | VT
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