Grace Yasewicz
Individual provider Active NPI Dentist · Burlington, VT
NPI 1336899848 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1336899848
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 016-0133835 (VT)
- Practice address
- 111 Colchester Ave
Burlington, VT 05401-1473 - Phone
- (802) 847-2345
- NPI assigned
- Mar 27, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016-0133835 | VT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Vermont Medical Center Inc | Past | Accepting new patients |
Interoperability endpoints
- gyasewicz483992@direct.uvmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 016-0133835 | VT | Yes |
Addresses
Primary practice location
111 Colchester Ave
Burlington, VT 05401-1473
Mailing address
111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-2345
Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.