Provider Demographics
NPI:1982104675
Name:THE DENTISTS ON PEARL
Entity Type:Organization
Organization Name:THE DENTISTS ON PEARL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-309-4431
Mailing Address - Street 1:313 S BAY CIR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3890
Mailing Address - Country:US
Mailing Address - Phone:802-309-4431
Mailing Address - Fax:
Practice Address - Street 1:49 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3622
Practice Address - Country:US
Practice Address - Phone:802-878-4631
Practice Address - Fax:802-878-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0094121261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1992071799Medicaid
VT134637810Medicaid
VT1306106083Medicaid