Provider Demographics
NPI:1275648487
Name:VERMONT ENDODONTICS PLLC
Entity Type:Organization
Organization Name:VERMONT ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:PETROPULOS
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-872-0300
Mailing Address - Street 1:75 TALCOTT ROAD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-872-0300
Mailing Address - Fax:802-872-0500
Practice Address - Street 1:75 TALCOTT ROAD
Practice Address - Street 2:SUITE 20
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-872-0300
Practice Address - Fax:802-872-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600020711223E0200X
VT01600020401223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty