GREEN MOUNTAIN ORAL SURGERY LLC NPI 1780886036

NPI Information

  • NPI: 1780886036
  • Provider Name: GREEN MOUNTAIN ORAL SURGERY LLC
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Organization
  • Address: 66 N MAIN ST
    RUTLAND, VT
    ZIP 05701
  • Phone: (802) 775-9700

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NPI Details

GREEN MOUNTAIN ORAL SURGERY LLC is an oral and maxillofacial surgery dentist in Rutland, VT. The provider is an oral and maxillofacial surgery dentist 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. GREEN MOUNTAIN ORAL SURGERY LLC NPI is 1780886036. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

66 N MAIN ST
RUTLAND, VT
ZIP 05701-249
Phone: (802) 775-9700
Fax: (802) 775-3237

The provider's authorized official is Sherilynn Stofka .
The authorized official title is Oral Surgeon and has the following contact phone number (802) 775-9700.

The enumeration date for this NPI number is 5/31/2007 and was last updated on 8/22/2020.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery0160002076VERMONTYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11006523MEDICAIDVERMONT

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: 11/21/2025

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