Provider Demographics
NPI:1710950092
Name:NORTHERN VERMONT ORAL & FACIAL SURGERY
Entity Type:Organization
Organization Name:NORTHERN VERMONT ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-223-2364
Mailing Address - Street 1:310 FISHER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9162
Mailing Address - Country:US
Mailing Address - Phone:802-223-2364
Mailing Address - Fax:802-223-9691
Practice Address - Street 1:310 FISHER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9162
Practice Address - Country:US
Practice Address - Phone:802-223-2364
Practice Address - Fax:802-223-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003048Medicaid
VT1003048Medicaid