Organization
DR. KENNETH J. STAVISKY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARTHA WHITCOMB PHILBRICK (OFFICE MANAGER)
(802) 865-1212
Entity
Organization
Contact information
Practice address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7303
(802) 865-1212
(802) 865-4666
Mailing address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7303
(802) 865-1212
(802) 865-4666
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
01600001242
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962512038
INDIVIDUAL NPI
VT
Enumeration date
10/25/2006
Last updated
08/22/2020
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