Organization
H
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HULL (CLINIC COORDINATOR)
(802) 889-3310
Entity
Organization
Contact information
Practice address
79 SOUTH WINDSOR ST, SOUTH ROYALTON, VT 05068-0119
(802) 889-3310
(802) 763-2190
Mailing address
PO BOX 119, SOUTH ROYALTON, VT 05068-0119
(802) 889-3310
(802) 763-2190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
659
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016989
—
VT
Enumeration date
05/03/2011
Last updated
05/03/2011
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