Provider Demographics
NPI:1194149641
Name:AC DENTAL CARE, INC. DBA RED CLOVER FAMILY DENTISTRY
Entity type:Organization
Organization Name:AC DENTAL CARE, INC. DBA RED CLOVER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-238-7921
Mailing Address - Street 1:61 PINE ST
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1043
Mailing Address - Country:US
Mailing Address - Phone:802-453-3911
Mailing Address - Fax:802-329-2358
Practice Address - Street 1:61 PINE ST
Practice Address - Street 2:BUILDING 4
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-3911
Practice Address - Fax:802-329-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental