# GREEN MOUNTAIN PEDIATRIC DENTISTRY, PLLC

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

## Provider details

- **NPI number:** 1912469297
- **Authorized official:** BARRY L JACOBSON DMD (OWNER)
- **Authorized official phone:** (802) 332-6808

## Contact information

- **Practice address:** 42 TIMBER LN, SOUTH BURLINGTON, VT 05403-7204
- **Practice address phone:** (802) 332-6808
- **Practice address fax:** (802) 332-6807
- **Mailing address:** 42 TIMBER LN, SOUTH BURLINGTON, VT 05403-7204
- **Mailing address phone:** (802) 332-6808
- **Mailing address fax:** (802) 332-6807

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/04/2019
- **Last updated:** 04/04/2019