Provider Demographics
NPI:1386016970
Name:JUST KIDS PEDIATRIC DENTISTRY, PLC
Entity Type:Organization
Organization Name:JUST KIDS PEDIATRIC DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:802-649-5210
Mailing Address - Street 1:303 ROUTE 5 S UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-9466
Mailing Address - Country:US
Mailing Address - Phone:802-649-5210
Mailing Address - Fax:802-649-7284
Practice Address - Street 1:303 ROUTE 5 S UNIT 2
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:VT
Practice Address - Zip Code:05055-9466
Practice Address - Country:US
Practice Address - Phone:802-649-5210
Practice Address - Fax:802-649-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01110941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty