# GREEN MOUNTAIN ORAL SURGERY LLC

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

## Provider details

- **NPI number:** 1780886036
- **Authorized official:** DR. SHERILYNN STOFKA D.D.S. (ORAL SURGEON)
- **Authorized official phone:** (802) 775-9700

## Contact information

- **Practice address:** 66 N MAIN ST, RUTLAND, VT 05701-3249
- **Practice address phone:** (802) 775-9700
- **Practice address fax:** (802) 775-3237
- **Mailing address:** 66 N MAIN ST, RUTLAND, VT 05701-3249
- **Mailing address phone:** (802) 775-9700
- **Mailing address fax:** (802) 775-3237

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0160002076 | VT | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 08/22/2020