Provider Demographics
NPI:1669825659
Name:GOLDEN 246 NORTH MAIN PLLC
Entity Type:Organization
Organization Name:GOLDEN 246 NORTH MAIN PLLC
Other - Org Name:ASSOCIATES IN COMPREHENSIVE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-878-1170
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:25 BISHOP AVE
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1277
Mailing Address - Country:US
Mailing Address - Phone:802-878-1170
Mailing Address - Fax:802-872-7139
Practice Address - Street 1:25 BISHOP AVE
Practice Address - Street 2:
Practice Address - City:WILISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-878-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160120271122300000X
VT0160088849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty