Individual
DR. KENNETH JOSEPH STAVISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7324
(802) 865-1212
(802) 865-4666
Mailing address
99 SWIFT ST, SUITE 115, SOUTH BURLINGTON, VT 05403-7324
(802) 865-1212
(802) 865-4666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0160001242
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
867774
TRICARE UNITED CONCORDIA
—
Enumeration date
08/30/2006
Last updated
07/08/2007
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