1386660082 NPI number — AFFILIATES IN DENTAL CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386660082 NPI number — AFFILIATES IN DENTAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATES IN DENTAL CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386660082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-773-6966
Provider Business Mailing Address Fax Number:
802-773-6924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-773-6966
Provider Business Practice Location Address Fax Number:
802-773-6924
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
CLINTON
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
802-773-6966

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1004256 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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