Provider Demographics
NPI:1861459323
Name:DAHLIN, DONALD D (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:DAHLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:D
Other - Last Name:DAHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-4463
Mailing Address - Country:US
Mailing Address - Phone:802-334-6766
Mailing Address - Fax:
Practice Address - Street 1:83 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4463
Practice Address - Country:US
Practice Address - Phone:802-334-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00010701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009243Medicaid