Provider Demographics
NPI:1497049746
Name:MILTON FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:MILTON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PECOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-999-6245
Mailing Address - Street 1:157 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3607
Mailing Address - Country:US
Mailing Address - Phone:802-893-4734
Mailing Address - Fax:
Practice Address - Street 1:157 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3607
Practice Address - Country:US
Practice Address - Phone:802-893-4734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600022771223G0001X
VT01600006771223G0001X
VT01600021401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty