Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 016-0087001 | VT |
Y | 122300000X | Dentist | 057154 | NY |
N | 122300000X | Dentist | DEN4224 | ME |
N | 1223D0001X | Dental Public Health | 016-0087001 | VT |
N | 1223D0001X | Dental Public Health | 16-0087001 | VT |
NPI | 1053608521 |
---|---|
Provider Name | Joshua Bratt |
First Address | Morrisville, VT 05661-0749 |
Second Address | Rockville Ctr, NY 11570-4438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021135 | (05) | VT |