Provider Demographics
NPI:1992990071
Name:LISCIO FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:LISCIO FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-658-4873
Mailing Address - Street 1:369 HEINEBERG DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6774
Mailing Address - Country:US
Mailing Address - Phone:802-658-4873
Mailing Address - Fax:
Practice Address - Street 1:369 HEINEBERG DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6774
Practice Address - Country:US
Practice Address - Phone:802-658-4873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-0000868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00002459Medicaid