Provider Demographics
NPI:1588879472
Name:DAN MELO , DMD , PLC
Entity type:Organization
Organization Name:DAN MELO , DMD , PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
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:802-985-3500
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-0862
Mailing Address - Country:US
Mailing Address - Phone:802-985-3500
Mailing Address - Fax:802-985-2979
Practice Address - Street 1:30 SHELBURNE SHOPPING PARK
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7488
Practice Address - Country:US
Practice Address - Phone:802-985-3500
Practice Address - Fax:802-985-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160002103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013674Medicaid