VT Center for Dental Implants and Maxillofacial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

061-0001123 Issued in VT

Legal business name

VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC

Practice address

792 College Pkwy Ste 307
Colchester, VT 05446-3052

Phone

(802) 655-5090

Fax

(802) 655-9366

NPI assigned

Jan 24, 2008

Last updated

Apr 25, 2024By 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

Lisa Marie Dike

Title

Practice Manager

Phone

(802) 655-5090

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Dr. Albert S. Hardy Former legal business name

Tax ID family

Dr Albert S Hardy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• VT Center for Dental Implants and Maxillofacial Surgery LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Stowe, VT
  • NPI 1104465657
  NPD tax ID

Locations

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1063699767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 COLLEGE PKWY STE 307",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054463052",
            "telephone_number": "802-655-5090",
            "fax_number": "802-655-9366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "792 COLLEGE PKWY STE 307",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054463052",
            "telephone_number": "802-655-5090",
            "fax_number": "802-655-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-24",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "DIKE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "802-655-5090"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "VT",
            "license": "061-0001123",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VT",
            "license": "016-0001123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003069",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Albert S. Hardy",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Dr. Albert S. Hardy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery Clinic/Center in Colchester, VT
• Providers in Colchester, VT by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; 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.