Individual
ADISA RATANASIRINTRAWOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1775 WILLISTON RD, SOUTH BURLINGTON, VT 05403-6491
(802) 863-5447
Mailing address
77 PINE ST APT 509, BURLINGTON, VT 05401-5945
(857) 361-2255
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
016.0134058
VT
Other
Enumeration date
10/18/2018
Last updated
09/28/2021
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