Provider Demographics
NPI:1740301571
Name:MILTON FAMILY DENTISTRY
Entity type:Organization
Organization Name:MILTON FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLINGEBIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-893-4734
Mailing Address - Street 1:157 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-3607
Mailing Address - Country:US
Mailing Address - Phone:802-893-4734
Mailing Address - Fax:
Practice Address - Street 1:157 RIVER ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3607
Practice Address - Country:US
Practice Address - Phone:802-893-4734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009136Medicaid
VT0001886Medicaid