Individual
TYLER STANWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
62 MERCHANTS ROW STE 104, WILLISTON, VT 05495-4476
(802) 497-6310
Mailing address
62 MERCHANTS ROW STE 104, WILLISTON, VT 05495-4476
(802) 497-6310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
016.0134180
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/23/2023
Last updated
05/02/2023
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