| Vermont Orofacial Pain Associates | |
|
40 Timber Ln South Burlington VT 05403-7204 | |
| (802) 862-7185 | |
| (802) 658-8036 |
| Full Name | Vermont Orofacial Pain Associates |
|---|---|
| Speciality | Dentist |
| Location | 40 Timber Ln, South Burlington, Vermont |
| Authorized Official Name and Position | Reimy Evangelista De Leon (OWNER) |
| Authorized Official Contact | 7813850484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vermont Orofacial Pain Associates 40a Timber Ln South Burlington VT 05403-7204 Ph: (802) 862-7185 | Vermont Orofacial Pain Associates 40 Timber Ln South Burlington VT 05403-7204 Ph: (802) 862-7185 |
| NPI Number | 1932245362 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 01/17/2024 |
| Medicare PECOS PAC ID | 9931203601 |
|---|---|
| Medicare Enrollment ID | O20070406000159 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932245362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 016-0000615 (Vermont) | Primary |
| Provider Name | Jeffrey A Crandall |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790711414 PECOS PAC ID: 7719900687 Enrollment ID: I20060105000683 |
| Provider Name | Andres Pinto |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1437280583 PECOS PAC ID: 1254392863 Enrollment ID: I20191016002280 |
| Provider Name | Manvitha Reddy Kuchukulla |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1760073449 PECOS PAC ID: 9234545740 Enrollment ID: I20210309000385 |
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