MEDICARE: THE DENTISTS ON PEARL

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	261QD0000X	Dental Clinic/Center	016.0094121	VT

Other Identifiers

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

General Provider Information

NPI Number	:	1982104675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTISTS ON PEARL

Provider Business Mailing Address
First Line	:	313 S BAY CIR
Second Line	:
City	:	COLCHESTER
State	:	VT
Zip	:	05446-3890
Country	:	US
Telephone Number	:	802-309-4431
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 PEARL ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3622
Country	:	US
Telephone Number	:	802-878-4631
Fax Number	:	802-878-8481

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. SARAH EVANS
Credential	:	DDS
Telephone Number	:	802-309-4431

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	02/19/2018

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Directions to “THE DENTISTS ON PEARL ” Practice Location

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