Provider Demographics
NPI:1407847916
Name:CONGALTON, DAVID ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:CONGALTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S WILLIAMS ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3452
Mailing Address - Country:US
Mailing Address - Phone:802-859-1534
Mailing Address - Fax:
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1154
Practice Address - Country:US
Practice Address - Phone:802-877-3534
Practice Address - Fax:802-877-3409
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160002123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008099Medicaid