| Mallett's Bay Dentistry | |
|
97 Blakely Rd Suite 104 Colchester VT 05446-4008 | |
| (802) 862-8266 | |
| (802) 862-6416 |
| Full Name | Mallett's Bay Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 97 Blakely Rd, Colchester, Vermont |
| Authorized Official Name and Position | Denham B. Crafton (CEO) |
| Authorized Official Contact | 8028628266 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mallett's Bay Dentistry 97 Blakely Rd Suite 104 Colchester VT 05446-4008 Ph: (802) 862-8266 | Mallett's Bay Dentistry 97 Blakely Rd Suite 104 Colchester VT 05446-4008 Ph: (802) 862-8266 |
| NPI Number | 1477851723 |
|---|---|
| Provider Enumeration Date | 03/10/2011 |
| Last Update Date | 03/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477851723 | NPI | - | NPPES |
| 1015584 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 016-0002281 (Vermont) | Primary |
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Crafton Family Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 97 Blakely Rd, Suite 104, Colchester, VT 05446 Phone: 802-862-8266 Fax: 802-862-6416 |