Provider Demographics
NPI:1053784595
Name:ACDCDDS,PC
Entity type:Organization
Organization Name:ACDCDDS,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-878-1170
Mailing Address - Street 1:25 BISHOP AVE
Mailing Address - Street 2:P.O. BOX 1277
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7871
Mailing Address - Country:US
Mailing Address - Phone:820-878-1170
Mailing Address - Fax:802-872-7139
Practice Address - Street 1:25 BISHOP AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7871
Practice Address - Country:US
Practice Address - Phone:820-878-1170
Practice Address - Fax:802-872-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00888491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty