Provider Demographics
NPI:1568174159
Name:VERMONT FAMILY DENTAL PLC
Entity Type:Organization
Organization Name:VERMONT FAMILY DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JP
Authorized Official - Middle Name:
Authorized Official - Last Name:RABBATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-947-0020
Mailing Address - Street 1:135 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3238
Mailing Address - Country:US
Mailing Address - Phone:802-770-1730
Mailing Address - Fax:
Practice Address - Street 1:135 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3238
Practice Address - Country:US
Practice Address - Phone:802-770-1730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERMONT FAMILY DENTAL PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental