Provider Demographics
NPI:1437792983
Name:BRISTOL PARK DENTAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:BRISTOL PARK DENTAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIDZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-453-7700
Mailing Address - Street 1:6 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1229
Mailing Address - Country:US
Mailing Address - Phone:802-453-7700
Mailing Address - Fax:802-453-7748
Practice Address - Street 1:6 PARK PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1229
Practice Address - Country:US
Practice Address - Phone:802-453-7700
Practice Address - Fax:802-453-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty