Dr. Kenneth J. Stavisky, LTD.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

01600001242 Issued in VT

Legal business name

DR. KENNETH J. STAVISKY, LTD.

Practice address

99 Swift St
Suite 115
South Burlington, VT 05403-7303

Phone

(802) 865-1212

Fax

(802) 865-4666

NPI assigned

Oct 25, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Martha Whitcomb Philbrick

Title

Office Manager

Phone

(802) 865-1212

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Kenneth Joseph Stavisky, DMD

  • Dentist
  • South Burlington, VT
  • NPI 1962512038
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942384979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 SWIFT ST",
            "address_2": "SUITE 115",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037303",
            "telephone_number": "802-865-1212",
            "fax_number": "802-865-4666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 SWIFT ST",
            "address_2": "SUITE 115",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037303",
            "telephone_number": "802-865-1212",
            "fax_number": "802-865-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. KENNETH J. STAVISKY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PHILBRICK",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "WHITCOMB",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "802-865-1212",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VT",
            "license": "01600001242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1962512038",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Donahue, MSW, LICSW
• Dorset Street Dermatology
• Dorset Street Family Dental PLC
• Stephanie Kay Douglas, PT
• Callie Douglass, MA
• Corrin O Drosin, LICSW
• DRS. Marko Family Chiropractors
• DTGC, PC (Vermont Dermatopathology)
• Jenal Dumas, LADC, LICSW
• Angela Dunkling

• Endodontics in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Endodontics in Vermont

• 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.