Provider Demographics
NPI:1689619074
Name:ASSOCIATES IN PERIODONTICS, PLC
Entity Type:Organization
Organization Name:ASSOCIATES IN PERIODONTICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-863-5447
Mailing Address - Street 1:247 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8572
Mailing Address - Country:US
Mailing Address - Phone:802-863-5447
Mailing Address - Fax:
Practice Address - Street 1:247 PEARL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8572
Practice Address - Country:US
Practice Address - Phone:802-863-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-009811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009673Medicare UPIN
VT6215270001Medicare NSC