MEDICARE: MANCHESTER DENTAL GROUP PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1245860774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHESTER DENTAL GROUP PLC

Provider Business Mailing Address
First Line	:	39 ELM ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 ELM ST
Second Line	:
City	:	MANCHESTER CENTER
State	:	VT
Zip	:	05255-9639
Country	:	US
Telephone Number	:	802-362-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD MILLER
Credential	:	DMD
Telephone Number	:	617-921-6292

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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Directions to “MANCHESTER DENTAL GROUP PLC ” Practice Location

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