Provider Demographics
NPI:1922120484
Name:BARTON STREET DENTAL
Entity Type:Organization
Organization Name:BARTON STREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-222-5776
Mailing Address - Street 1:21 BARTON STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033
Mailing Address - Country:US
Mailing Address - Phone:802-222-5776
Mailing Address - Fax:
Practice Address - Street 1:21 BARTON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033
Practice Address - Country:US
Practice Address - Phone:802-222-5776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1214261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental