Provider Demographics
NPI:1811559446
Name:ST. ALBANS DENTAL PLC
Entity Type:Organization
Organization Name:ST. ALBANS DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-793-9633
Mailing Address - Street 1:34 MAPLEVILLE DEPOT
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1857
Mailing Address - Country:US
Mailing Address - Phone:802-524-4844
Mailing Address - Fax:
Practice Address - Street 1:34 MAPLEVILLE DEPOT
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1857
Practice Address - Country:US
Practice Address - Phone:802-524-4844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty