Individual
JITKA H. MATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
66 MORRISVILLE PLZ, MORRISVILLE, VT 05661-4482
(802) 888-7585
(802) 851-8313
Mailing address
PO BOX 749, MORRISVILLE, VT 05661-0749
(802) 888-7585
(802) 851-8313
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0160105895
VT
1223G0001X
General Practice Dentistry
13268
MD
Other
Enumeration date
05/02/2007
Last updated
09/23/2014
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