Provider Demographics
NPI:1861436859
Name:VENMAR, RICHARD SCOTT
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:VENMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3424
Mailing Address - Country:US
Mailing Address - Phone:802-476-3171
Mailing Address - Fax:802-476-8788
Practice Address - Street 1:20 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3424
Practice Address - Country:US
Practice Address - Phone:802-476-3171
Practice Address - Fax:802-476-8788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002441Medicaid
PADS021234LOtherDENTAL LICENSE
PADN021234AOtherANESTHESIA PERMIT