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Organization

VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC

Active
Other names
Dr. Albert S. Hardy
Organization subpart
No

Provider details

NPI number
Authorized official
LISA MARIE DIKE (PRACTICE MANAGER)
(802) 655-5090
Entity
Organization

Contact information

Practice address
792 COLLEGE PKWY STE 307, COLCHESTER, VT 05446-3052
(802) 655-5090
(802) 655-9366
Mailing address
792 COLLEGE PKWY STE 307, COLCHESTER, VT 05446-3052
(802) 655-5090
(802) 655-9366

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
016-0001123
VT
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
061-0001123
VT
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1003069
VT
Enumeration date
01/24/2008
Last updated
04/25/2024
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