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General NPI Number Information
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NPI Number | 1972656734
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Entity Type | Organization
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Legal Business Name | ERNEST S. MELANSON, DDS,MS,PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 WINTHROP ST
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City | WORCESTER
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State | MA
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Zip | 01604-4435
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Country | US
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Telephone | 508-755-2207
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Fax | 508-755-2275
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Provider Business Mailing Address
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Address Line | 10 WINTHROP ST
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City | WORCESTER
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State | MA
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Zip | 01604-4435
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Country | US
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Telephone | 508-755-2207
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Fax | 508-755-2275
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST S. MELANSON
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Credential | DDS, MS
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Telephone | 508-755-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 10787
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License Number State | MA
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