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Organization
DR. KENNETH J. STAVISKY, LTD.
Active
Organization
DR. KENNETH J. STAVISKY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA WHITCOMB PHILBRICK (OFFICE MANAGER)
(802) 865-1212
Entity
Organization
Contact information
Practice address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7303
(802) 865-1212
(802) 865-4666
Mailing address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7303
(802) 865-1212
(802) 865-4666
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
01600001242
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962512038
INDIVIDUAL NPI
VT
Enumeration date
10/25/2006
Last updated
08/22/2020
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