NPIMap

Organization Active NPI

The Dental Center at Community Health Center of Burlington

  • Dental Clinic/Center
  • Burlington, VT
National Provider Identifier
1053460907
Registry record updated Nov 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
THE DENTAL CENTER AT COMMUNITY HEALTH CENTER OF BURLINGTON
Practice address
617 Riverside Ave
Burlington, VT 05401-1601
Phone
(802) 864-6309
Fax
(802) 860-4324
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diana Greenough
Title
Director
Phone
(802) 864-6309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

617 Riverside Ave
Burlington, VT 05401-1601

Mailing address

617 Riverside Ave
Burlington, VT 05401-1601
Phone (802) 864-6309

Other identifiers 1

IdentifierTypeStateIssuer
0001692MedicaidVT

National Provider Directory

National Provider Directory
Tax ID family
Community Health Centers of Burlington Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446768000000",
    "number": "1053460907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 RIVERSIDE AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011601",
            "telephone_number": "802-864-6309",
            "fax_number": "802-860-4324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 RIVERSIDE AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011601",
            "telephone_number": "802-864-6309",
            "fax_number": "802-860-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL CENTER AT COMMUNITY HEALTH CENTER OF BURLINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2015-11-06",
        "status": "A",
        "authorized_official_last_name": "GREENOUGH",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "802-864-6309"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001692",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.