Organization
PAUL KENWORTHY DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL KENWORTHY DMD (OWNER/DENTIST)
(802) 879-5151
Entity
Organization
Contact information
Practice address
1 PLACE NOTRE DAME, ST JOHNSBURY, VT 05819-2223
(802) 879-5151
(866) 561-8426
Mailing address
4 KELLOGG RD, ESSEX JUNCTION, VT 05452-2815
(802) 879-5151
(866) 561-8426
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
975
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2551
—
VT
Enumeration date
05/06/2015
Last updated
10/26/2015
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