Stavisky, Kenneth Joseph

Stavisky, Kenneth Joseph is an individual health care provider with primary practice located at 99 Swift St Suite 115, South Burlington VT 05403-7324. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Stavisky, Kenneth Joseph can be contacted via phone (802) 865-1212.

Contact Information

Primary practice address
99 Swift St Suite 115 South Burlington VT 05403-7324
Phone: (802) 865-1212
Fax: (802) 865-4666
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 0160001242 Vermont

Profile Details

NPI number 1962512038
LBN Legal business name Stavisky, Kenneth Joseph
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962512038 NPPES
Other 867774 TRICARE UNITED CONCORDIA

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