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212 Prouty Dr Suite 1 Newport VT 05855-9851 | |
| (802) 334-6965 | |
| (802) 334-6606 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 212 Prouty Dr, Newport, Vermont |
| Authorized Official Name and Position | James Vincent Wyllie (OWNER) |
| Authorized Official Contact | 8023346965 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
212 Prouty Dr Suite 1 Newport VT 05855-9851 Ph: (802) 334-6965 | 212 Prouty Dr Suite 1 Newport VT 05855-9851 Ph: (802) 334-6965 |
| NPI Number | 1760695597 |
|---|---|
| Provider Enumeration Date | 05/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760695597 | NPI | - | NPPES |
| 000-1845 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 652 (Vermont) | Primary |