Keydel, Mark Thomas
Keydel, Mark Thomas is an individual health care provider with primary practice located at 52 Colchester Ave , Burlington VT 05401. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Keydel, Mark Thomas can be contacted via phone (802) 864-0353.Contact Information
Primary practice address
52 Colchester Ave
Burlington VT 05401
Phone: (802) 864-0353
Fax: (802) 865-9414
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | VT851 | Vermont |
Profile Details
| NPI number | 1417099920 |
|---|---|
| LBN Legal business name | Keydel, Mark Thomas |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 12th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417099920 | NPPES |
| Vermont | MEDICAID | 0002450 |
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