Provider Demographics
NPI:1588849004
Name:JANISSE, MARGARET NASSYM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:NASSYM
Last Name:JANISSE
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 1:217 MAXHAM MEADOW WAY # 10
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-1162
Mailing Address - Country:US
Mailing Address - Phone:802-457-1903
Mailing Address - Fax:
Practice Address - Street 1:217 MAXHAM MEADOW WAY # 10
Practice Address - Street 2:SUITE 104C
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1162
Practice Address - Country:US
Practice Address - Phone:802-457-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00022481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice