Provider Demographics
NPI:1932245362
Name:VERMONT DENTAL MEDICINE PLLC
Entity Type:Organization
Organization Name:VERMONT DENTAL MEDICINE PLLC
Other - Org Name:VERMONT OROFACIAL PAIN ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REIMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANGELISTA DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, CAGS, MS
Authorized Official - Phone:781-385-0484
Mailing Address - Street 1:40A TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7204
Mailing Address - Country:US
Mailing Address - Phone:802-862-7185
Mailing Address - Fax:802-658-8036
Practice Address - Street 1:40 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7204
Practice Address - Country:US
Practice Address - Phone:802-862-7185
Practice Address - Fax:802-658-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-0000615122300000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental