1871705178 NPI number — RICHARD BRUCE METZ DMD

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 1871705178 NPI number — RICHARD BRUCE METZ DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD BRUCE METZ DMD
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:
1871705178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 387
Provider Second Line Business Mailing Address:
82 BALLARDS CORNER RD.
Provider Business Mailing Address City Name:
HINESBURG
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05461-0387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-482-3155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 BALLARDS CORNER RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINESBURG
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-482-3155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
METZ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
802-482-3155

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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