Healthcare Provider Details

I. General information

NPI: 1013410331
Provider Name (Legal Business Name): RUTLAND FAMILY DENTAL, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 STRATTON RD STE 2
RUTLAND VT
05701-4623
US

IV. Provider business mailing address

15 SPRINGHOUSE RD
SOUTH BURLINGTON VT
05403-7400
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-5777
  • Fax:
Mailing address:
  • Phone: 802-985-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAN MELO
Title or Position: MEMBER
Credential: DMD
Phone: 802-862-4993