Active NPI
Gerald R Theberge, DDS
- Dentist
- Brattleboro, VT
National Provider Identifier
1376570226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0160000888
- Practice address
- 72 High Street
Brattleboro, VT 05301 - Phone
- (802) 254-9644
- Fax
- (802) 257-8512
- NPI assigned
- Jun 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0160000888 | VT | Primary |
Addresses
Primary practice location
72 High Street
Brattleboro, VT 05301
Mailing address
72 High Street
Brattleboro, VT 05301
Phone (802) 254-9644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0160000888 | VT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Dental Care, PLLC. | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376570226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 HIGH STREET",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "05301",
"telephone_number": "802-254-9644",
"fax_number": "802-257-8512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 HIGH STREET",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "05301",
"telephone_number": "802-254-9644",
"fax_number": "802-257-8512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEBERGE",
"first_name": "GERALD",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VT",
"license": "0160000888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.