| Dr. Kenneth J. Stavisky, Ltd. | |
|
99 Swift St Suite 115 South Burlington VT 05403-7303 | |
| (802) 865-1212 | |
| (802) 865-4666 |
| Full Name | Dr. Kenneth J. Stavisky, Ltd. |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 99 Swift St, South Burlington, Vermont |
| Authorized Official Name and Position | Martha Whitcomb Philbrick (OFFICE MANAGER) |
| Authorized Official Contact | 8028651212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Kenneth J. Stavisky, Ltd. 99 Swift St Suite 115 South Burlington VT 05403-7303 Ph: (802) 865-1212 | Dr. Kenneth J. Stavisky, Ltd. 99 Swift St Suite 115 South Burlington VT 05403-7303 Ph: (802) 865-1212 |
| NPI Number | 1942384979 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942384979 | NPI | - | NPPES |
| 1962512038 | Other | VT | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 01600001242 (Vermont) | Primary |
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