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General NPI Number Information
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NPI Number | 1487058137
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Entity Type | Organization
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Legal Business Name | MORRISVILLE FAMILY DENTAL, PLC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 5 PARK ST. SUITE 365
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City | MORRISVILLE
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State | VT
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Zip | 05661
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Country | US
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Telephone | 802-888-3521
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Fax | 802-888-5973
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Provider Business Mailing Address
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Address Line | 5 PARK ST. SUITE 365
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City | MORRISVILLE
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State | VT
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Zip | 05661
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Country | US
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Telephone | 802-888-3521
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Fax | 802-888-5973
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN MELO
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Credential | DMD
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Telephone | 802-888-3521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0160106899
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License Number State | VT
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