Provider Demographics
NPI:1578623146
Name:ARMSTRONG, JOHN EDGAR HOOVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDGAR HOOVER
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:DDS
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 85
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-0085
Mailing Address - Country:US
Mailing Address - Phone:802-626-9573
Mailing Address - Fax:
Practice Address - Street 1:282 PINEHURST STREET
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-0085
Practice Address - Country:US
Practice Address - Phone:802-626-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0005671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT000-1701Medicaid