Organization
GREEN MOUNTAIN ORAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERILYNN STOFKA D.D.S. (ORAL SURGEON)
(802) 775-9700
Entity
Organization
Contact information
Practice address
66 N MAIN ST, RUTLAND, VT 05701-3249
(802) 775-9700
(802) 775-3237
Mailing address
66 N MAIN ST, RUTLAND, VT 05701-3249
(802) 775-9700
(802) 775-3237
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0160002076
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006523
—
VT
Enumeration date
05/31/2007
Last updated
08/22/2020
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