Middlebury Pediatric Dentistry, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MIDDLEBURY PEDIATRIC DENTISTRY, PLLC

Doing business as

Middlebury Pediatric Dentistry

Practice address

132 S Village GRN
Middlebury, VT 05753-6900

Phone

(802) 388-0909

Fax

(802) 989-7095

NPI assigned

Jun 23, 2020

Last updated

Jun 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian D Collins, DDSNPI 1790901015

Title

Owner / Member

Phone

(802) 388-0909

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Middlebury Pediatric Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brian Darnell Collins, D.D.S.

  • Pediatric Dentistry
  • Middlebury, VT
  • NPI 1790901015
  NPD Authorized official
• Brian Andrew Collins, DMD

  • Pediatric Dentistry
  • Middlebury, VT
  • NPI 1952895815
  NPD

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1053937292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 S VILLAGE GRN",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057536900",
            "telephone_number": "802-388-0909",
            "fax_number": "802-989-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 S VILLAGE GRN",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057536900",
            "telephone_number": "802-388-0909",
            "fax_number": "802-989-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLEBURY PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER / MEMBER",
        "authorized_official_telephone_number": "802-388-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022015",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Middlebury Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatric Dentistry in Middlebury, VT
• Providers in Middlebury, VT by specialty
• Pediatric Dentistry in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.