| Champlain Periodontal P.c. | |
|
37 Timber Ln South Burlington VT 05403-5201 | |
| (802) 862-1435 | |
| (802) 864-6998 |
| Full Name | Champlain Periodontal P.c. |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 37 Timber Ln, South Burlington, Vermont |
| Authorized Official Name and Position | Brian D Huber (OWNER) |
| Authorized Official Contact | 8028621435 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Champlain Periodontal P.c. 37 Timber Ln South Burlington VT 05403-5201 Ph: (802) 862-1435 | Champlain Periodontal P.c. 37 Timber Ln South Burlington VT 05403-5201 Ph: (802) 862-1435 |
| NPI Number | 1598884850 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598884850 | NPI | - | NPPES |
| 1006633 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 0160002033 (Vermont) | Primary |
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