# VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104465657
- **Authorized official:** MRS. KAREN DESLAURIERS (BILLING MANAGER)
- **Authorized official phone:** (802) 655-5090

## Contact information

- **Practice address:** 1009 S MAIN ST STE 1, STOWE, VT 05672-5275
- **Practice address phone:** (802) 253-2761
- **Practice address fax:** (802) 655-9366
- **Mailing address:** 792 COLLEGE PKWY STE 307, COLCHESTER, VT 05446-3052
- **Mailing address phone:** (802) 655-5090
- **Mailing address fax:** (800) 524-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 01/02/2020
- **Last updated:** 04/09/2024