Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | VT |
NPI | 1063533651 |
---|---|
Provider Name | Dr. George Michael Ciavola |
First Address | Rutland, VT 05701-3120 |
Second Address | Rutland, VT 05701-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |