Organization
MAPLE LEAF FAMILY DENTISTRY
Active
Other names
Brigham Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW S EBERT DMD (OWNER)
(802) 888-5685
Entity
Organization
Contact information
Practice address
58 BRIGHAM STREET, MORRISVILLE, VT 05661
(802) 888-5685
Mailing address
PO BOX 636, MORRISVILLE, VT 05661-0636
(802) 888-5685
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
016-0002038
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009502
—
VT
Enumeration date
06/06/2007
Last updated
08/22/2020
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