Provider Demographics
NPI:1063074821
Name:ALLEN POND DENTAL
Entity type:Organization
Organization Name:ALLEN POND DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOTTENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-775-0986
Mailing Address - Street 1:71 ALLEN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4544
Mailing Address - Country:US
Mailing Address - Phone:802-775-0986
Mailing Address - Fax:
Practice Address - Street 1:71 ALLEN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4544
Practice Address - Country:US
Practice Address - Phone:802-775-0986
Practice Address - Fax:802-419-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty