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NPI Code Detail

MEDICARE: STRATTON DENTAL ARTS

MEDICARE: STRATTON DENTAL ARTS
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
1261QD0000XDental Clinic/Center0160073365VT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861970006
Entity Type Code : Organization
Provider Name (Legal Business Name) : STRATTON DENTAL ARTS
Provider Business Mailing Address
First Line : 163 STRATTON RD
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4619
Country : US
Telephone Number : 802-442-9500
Fax Number :
Provider Business Practice Location Address
First Line : 163 STRATTON RD
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4619
Country : US
Telephone Number : 802-442-9500
Fax Number :
Authorized Official
Title or Position : OWNER/OPERATOR
Name : TYLER J CARMACK
Credential : D.M.D.
Telephone Number : 802-442-9500
Provider Enumeration Date : 07/31/2018
Last Update Date : 07/31/2018

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