Provider Demographics
NPI:1295777977
Name:VERMILLION DENTAL OFFICE PC
Entity type:Organization
Organization Name:VERMILLION DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-645-2044
Mailing Address - Street 1:39 W LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1141
Mailing Address - Country:US
Mailing Address - Phone:570-645-2044
Mailing Address - Fax:570-645-9660
Practice Address - Street 1:39 W LUDLOW ST
Practice Address - Street 2:
Practice Address - City:SUMMIT HILL
Practice Address - State:PA
Practice Address - Zip Code:18250-1141
Practice Address - Country:US
Practice Address - Phone:570-645-2044
Practice Address - Fax:570-645-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA188791223G0001X
PA182971223G0001X
PA312861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty