Provider Demographics
NPI:1124454145
Name:ACDCDDS, PC
Entity type:Organization
Organization Name:ACDCDDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-878-1170
Mailing Address - Street 1:25 BISHOP AVE
Mailing Address - Street 2:PO BOX 1277
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7871
Mailing Address - Country:US
Mailing Address - Phone:802-878-1170
Mailing Address - Fax:802-872-7139
Practice Address - Street 1:25 BISHOP AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7871
Practice Address - Country:US
Practice Address - Phone:802-878-1170
Practice Address - Fax:802-872-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600005251223G0001X
VT01600005341223G0001X
VT01600888491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty