NPIMap

Organization Active NPI

Maple Leaf Family Dentistry

Doing business as Brigham Dental Care

  • General Practice Dentistry
  • Morrisville, VT
National Provider Identifier
1912100256
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
016-0002038 Issued in VT
Legal business name
MAPLE LEAF FAMILY DENTISTRY
Doing business as
Brigham Dental Care
Practice address
58 Brigham Street
Morrisville, VT 05661
Phone
(802) 888-5685
NPI assigned
Jun 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Matthew S Ebert, DMDNPI 1356564470
Title
Owner
Phone
(802) 888-5685

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 016-0002038 VT Primary

Addresses

Primary practice location

58 Brigham Street
Morrisville, VT 05661

Mailing address

PO Box 636
Morrisville, VT 05661-0636
Phone (802) 888-5685

Other identifiers 1

IdentifierTypeStateIssuer
1009502MedicaidVT

Other names 1

  • Brigham Dental Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912100256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "056610636",
            "telephone_number": "802-888-5685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 BRIGHAM STREET",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "05661",
            "telephone_number": "802-888-5685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE LEAF FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EBERT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-888-5685",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "016-0002038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009502",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brigham Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morrisville, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.