Provider Demographics
NPI:1730238593
Name:GIULIANELLI, MATTHEW DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:GIULIANELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KIMBALL AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6833
Mailing Address - Country:US
Mailing Address - Phone:802-864-6264
Mailing Address - Fax:802-864-6402
Practice Address - Street 1:110 KIMBALL AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-864-6264
Practice Address - Fax:802-864-6402
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053862122300000X
VT016-00022291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00069459OtherBLUECROSS BLUESHIELD
VT1012935Medicaid
VT412187837OtherDELTA DENTAL