Provider Demographics
NPI:1992778260
Name:TOWNE, BRADFORD M (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:M
Last Name:TOWNE
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 1:310 FISHER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9162
Mailing Address - Country:US
Mailing Address - Phone:877-868-2364
Mailing Address - Fax:802-229-0166
Practice Address - Street 1:310 FISHER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9162
Practice Address - Country:US
Practice Address - Phone:877-868-2364
Practice Address - Fax:802-229-0166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002482Medicaid
VTVT2482Medicare ID - Type Unspecified
VT0002482Medicaid