Provider Demographics
NPI:1508875675
Name:ULLMAN, CHERYL LANG (DMD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LANG
Last Name:ULLMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702-0130
Mailing Address - Country:US
Mailing Address - Phone:802-773-7767
Mailing Address - Fax:802-775-7667
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4570
Practice Address - Country:US
Practice Address - Phone:802-773-7767
Practice Address - Fax:802-775-7667
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9346OtherBC/BS
VT1009354Medicaid
VT1124OtherDELTA DENTAL