Provider Demographics
NPI:1235757121
Name:BRATTLEBORO DENTAL CARE LLC
Entity Type:Organization
Organization Name:BRATTLEBORO DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAITALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANATRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-254-6634
Mailing Address - Street 1:80 FLAT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 FLAT ST STE 101
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3258
Practice Address - Country:US
Practice Address - Phone:802-254-6634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty