Organization
WEST RIVER FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED VERNON REDISKE D.D.S. (DENTIST)
(802) 365-4313
Entity
Organization
Contact information
Practice address
74 GRAFTON RD, TOWNSHEND, VT 05353-0262
(802) 365-4313
Mailing address
74 GRAFTON ROAD, PO BOX 262, TOWNSHEND, VT 05353
(802) 365-4313
(802) 365-4313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0160002226
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013633
—
VT
Enumeration date
02/05/2010
Last updated
02/05/2010
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