Provider Demographics
NPI:1306923867
Name:VERDERBER, CHARLES J (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:VERDERBER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05455-5492
Mailing Address - Country:US
Mailing Address - Phone:802-524-3757
Mailing Address - Fax:
Practice Address - Street 1:39 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1610
Practice Address - Country:US
Practice Address - Phone:802-527-7796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600010741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010490Medicaid