Provider Demographics
NPI:1033247705
Name:VERMONT DENTAL CARE
Entity Type:Organization
Organization Name:VERMONT DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SELEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-655-8822
Mailing Address - Street 1:32 B MALLETTS BAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1960
Mailing Address - Country:US
Mailing Address - Phone:802-655-8822
Mailing Address - Fax:802-655-4242
Practice Address - Street 1:32 B MALLETTS BAY AVENUE
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1960
Practice Address - Country:US
Practice Address - Phone:802-655-8822
Practice Address - Fax:802-655-4242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERMONT DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty