Provider Demographics
NPI:1063772523
Name:SYMANCYK, TARA LOWELL (DDS)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:LOWELL
Last Name:SYMANCYK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:LOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-0948
Mailing Address - Country:US
Mailing Address - Phone:802-295-2458
Mailing Address - Fax:802-295-3985
Practice Address - Street 1:1049 N HARTLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9704
Practice Address - Country:US
Practice Address - Phone:802-295-2458
Practice Address - Fax:802-295-3985
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00861141223G0001X
NH038811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice