Individual
GOPICHAND VALLABHANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
617 RIVERSIDE AVE, BURLINGTON, VT 05401-1601
(802) 864-6309
Mailing address
617 RIVERSIDE AVE, BURLINGTON, VT 05401-1601
(802) 864-6309
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0160002181
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160002181
STATE LICENSE
VT
05
—
1010394
—
VT
Enumeration date
10/04/2006
Last updated
11/26/2012
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