Provider Demographics
NPI:1811370638
Name:MOUNT MANSFIELD DENTISTRY PLC
Entity Type:Organization
Organization Name:MOUNT MANSFIELD DENTISTRY PLC
Other - Org Name:MOUNT MANSFIELD SEDATION AND GENERAL DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITCHLOW
Authorized Official - Suffix:
Authorized Official - Credentials:CAPPM
Authorized Official - Phone:802-244-6366
Mailing Address - Street 1:77 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1555
Mailing Address - Country:US
Mailing Address - Phone:802-244-6366
Mailing Address - Fax:
Practice Address - Street 1:77 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1555
Practice Address - Country:US
Practice Address - Phone:802-244-6366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty