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VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC NPI 1063699767


NPI Information

NPI: 1063699767
Provider Name: VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC

Former Legal Business Name: DR. ALBERT S. HARDY

Classification: Clinic/Center - 261QS0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
792 COLLEGE PKWY STE 307
COLCHESTER, VT
ZIP 05446
Phone: (802) 655-5090
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VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC is an oral and maxillofacial surgery clinic center in Colchester, VT. The provider is an oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC NPI is 1063699767. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Dr. Albert S. Hardy.

The provider's business location address is:

792 COLLEGE PKWY STE 307
COLCHESTER, VT
ZIP 05446-052
Phone: (802) 655-5090
Fax: (802) 655-9366

The provider's authorized official is Lisa Marie Dike .
The authorized official title is Practice Manager and has the following contact phone number (802) 655-5090.

The enumeration date for this NPI number is 1/24/2008 and was last updated on 4/25/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial Surgery016-0001123VERMONTNo
2261QS0112XClinic/CenterOral and Maxillofacial Surgery061-0001123VERMONTYes
3332B00000XDurable Medical Equipment & Medical SuppliesNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11003069MEDICAIDVERMONT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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