Provider Demographics
NPI:1790019719
Name:SINCLAIR DMD & MAYOTT DDS PC
Entity Type:Organization
Organization Name:SINCLAIR DMD & MAYOTT DDS PC
Other - Org Name:TREATING DENTISTS: CHRISTOPHER A. FAUVER, DDS -OR- MICHAEL A. FOSTER,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAUVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-885-3191
Mailing Address - Street 1:2 CHESTER ROAD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2902
Mailing Address - Country:US
Mailing Address - Phone:802-885-3191
Mailing Address - Fax:802-885-4373
Practice Address - Street 1:2 CHESTER ROAD
Practice Address - Street 2:SUITE 10 SPRINGFIELD PLAZA
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2902
Practice Address - Country:US
Practice Address - Phone:802-885-3191
Practice Address - Fax:802-885-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00021071223G0001X
VT016-00022061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007889Medicaid
U84612Medicare UPIN