Provider Demographics
NPI:1659814176
Name:AFFORDABLE DENTURES - BURLINGTON III, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - BURLINGTON III, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:STRATTHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-651-9033
Mailing Address - Street 1:1162 WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5723
Mailing Address - Country:US
Mailing Address - Phone:802-651-9033
Mailing Address - Fax:
Practice Address - Street 1:1162 WILLISTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5723
Practice Address - Country:US
Practice Address - Phone:802-651-9033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0002232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty