VT Center for Dental Implants and Maxillofacial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC

Practice address

1009 S Main St Ste 1
Stowe, VT 05672-5275

Phone

(802) 253-2761

Fax

(802) 655-9366

NPI assigned

Jan 2, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Karen Deslauriers

Title

Billing Manager

Phone

(802) 655-5090

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

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 Clinic/Center
  • Colchester, VT
  • NPI 1063699767
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Albert S Hardy III, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Colchester, VT
  • NPI 1902902646

  Oral and Maxillofacial Surgery

  NPD

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1104465657",
    "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": "800-524-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 S MAIN ST STE 1",
            "city": "STOWE",
            "state": "VT",
            "postal_code": "056725275",
            "telephone_number": "802-253-2761",
            "fax_number": "802-655-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VT CENTER FOR DENTAL IMPLANTS AND MAXILLOFACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "DESLAURIERS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "802-655-5090",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Town of Stowe
• Liming Tseng, LICAC., MACOM
• Jennifer Lynn Tuttle, N.D.
• Catherine Teresa Vishton, O.D.
• Melissa Volansky, MD
• Heidi E Wehr-Kubalova, PT
• Yan Wei
• Karen C Westervelt, MS, PGD, PT, ATC, O
• Whitney Boland Acupuncture
• Angela Winchell, NP

• All providers in Stowe, VT
• Oral and Maxillofacial Surgery (Dentist) in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.