Provider Demographics
NPI:1487058137
Name:MORRISVILLE FAMILY DENTAL, PLC
Entity type:Organization
Organization Name:MORRISVILLE FAMILY DENTAL, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-888-3521
Mailing Address - Street 1:5 PARK ST.
Mailing Address - Street 2:SUITE 365
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661
Mailing Address - Country:US
Mailing Address - Phone:802-888-3521
Mailing Address - Fax:802-888-5973
Practice Address - Street 1:5 PARK ST.
Practice Address - Street 2:SUITE 365
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-3521
Practice Address - Fax:802-888-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160106899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty