Organization
FAMILY DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT STEPHEN KOLODZEJ DMD (SENIOR PARTNER)
(802) 775-0819
Entity
Organization
Contact information
Practice address
4 GENERAL WING RD, RUTLAND, VT 05701-4682
(802) 775-0819
(802) 775-1487
Mailing address
4 GENERAL WING RD, RUTLAND, VT 05701-4682
(802) 775-0819
(802) 775-1487
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1112
VT
1223G0001X
General Practice Dentistry
Primary
769
VT
1223G0001X
General Practice Dentistry
871
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000430
—
VT
01
—
FAMI2398
BLUE CROSS BLUE SHIELD
VT
Enumeration date
07/17/2007
Last updated
07/17/2007
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