|
| |
|
39 Congress Street St Albans VT 05478-1610 | |
| (802) 524-9774 | |
| (802) 524-9789 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 39 Congress Street, St Albans, Vermont |
| Authorized Official Name and Position | Lynda M Ulrich (CO-OWNER) |
| Authorized Official Contact | 8025277796 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
39 Congress Street St Albans VT 05478-1610 Ph: (802) 524-9774 | 39 Congress Street St Albans VT 05478-1610 Ph: (802) 524-9774 |
| NPI Number | 1194738088 |
|---|---|
| Provider Enumeration Date | 08/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194738088 | NPI | - | NPPES |
| 1010490 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0160001060 (Vermont) | Secondary |
| 1223G0001X | Dentist - General Practice | 0160001074 (Vermont) | Primary |