Provider Demographics
NPI:1891710794
Name:MICCOLO, JANET THOMASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:THOMASON
Last Name:MICCOLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 HINESBURG RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7628
Mailing Address - Country:US
Mailing Address - Phone:802-847-1777
Mailing Address - Fax:
Practice Address - Street 1:1060 HINESBURG RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7628
Practice Address - Country:US
Practice Address - Phone:802-847-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00008431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice