Provider Demographics
NPI:1457638892
Name:UPPER VALLEY ENDODONTICS
Entity Type:Organization
Organization Name:UPPER VALLEY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLICHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-295-7522
Mailing Address - Street 1:205 BILLINGS FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-5400
Mailing Address - Country:US
Mailing Address - Phone:802-295-7522
Mailing Address - Fax:802-296-2012
Practice Address - Street 1:205 BILLINGS FARM RD
Practice Address - Street 2:SUITE 6A
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-5400
Practice Address - Country:US
Practice Address - Phone:802-295-7522
Practice Address - Fax:802-296-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT495671223E0200X
VT016.00939231223E0200X
1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty