Provider Demographics
NPI:1477672632
Name:YOSSRI KAIRLIS
Entity Type:Organization
Organization Name:YOSSRI KAIRLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOSSRI
Authorized Official - Middle Name:MAHIR
Authorized Official - Last Name:KAIRLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-251-1031
Mailing Address - Street 1:130 BIRGE ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6460
Mailing Address - Country:US
Mailing Address - Phone:802-251-1031
Mailing Address - Fax:802-251-0022
Practice Address - Street 1:130 BIRGE ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6460
Practice Address - Country:US
Practice Address - Phone:802-251-1031
Practice Address - Fax:802-251-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160002043302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006272Medicaid