NPIMap

Organization Active NPI

H

  • General Practice Dentistry
  • South Royalton, VT
National Provider Identifier
1356633895
Registry record updated May 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
659 Issued in VT
Legal business name
H
Practice address
79 South Windsor St
South Royalton, VT 05068-0119
Phone
(802) 889-3310
Fax
(802) 763-2190
NPI assigned
May 3, 2011
Last updated
May 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2011

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

Authorized official

Name
Susan Hull
Title
Clinic Coordinator
Phone
(802) 889-3310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 659 VT Primary

Addresses

Primary practice location

79 South Windsor St
South Royalton, VT 05068-0119

Mailing address

PO Box 119
South Royalton, VT 05068-0119
Phone (802) 889-3310

Other identifiers 1

IdentifierTypeStateIssuer
1016989MedicaidVT

National Provider Directory

National Provider Directory
Tax ID family
H2 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.

NPI Registry JSON

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304380800000",
    "number": "1356633895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 119",
            "city": "SOUTH ROYALTON",
            "state": "VT",
            "postal_code": "050680119",
            "telephone_number": "802-889-3310",
            "fax_number": "802-763-2190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 SOUTH WINDSOR ST",
            "city": "SOUTH ROYALTON",
            "state": "VT",
            "postal_code": "050680119",
            "telephone_number": "802-889-3310",
            "fax_number": "802-763-2190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2011-05-03",
        "status": "A",
        "authorized_official_last_name": "HULL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "802-889-3310"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016989",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Royalton, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; 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.