Provider Demographics
NPI:1376986364
Name:DORSET STREET FAMILY DENTAL PLC
Entity Type:Organization
Organization Name:DORSET STREET FAMILY DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:HEMSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-860-3368
Mailing Address - Street 1:165 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6251
Mailing Address - Country:US
Mailing Address - Phone:802-860-3368
Mailing Address - Fax:802-860-3367
Practice Address - Street 1:165 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6251
Practice Address - Country:US
Practice Address - Phone:802-860-3368
Practice Address - Fax:802-860-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600889731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty