Provider Demographics
NPI:1013410331
Name:RUTLAND FAMILY DENTAL, PLC
Entity Type:Organization
Organization Name:RUTLAND FAMILY DENTAL, PLC
Other - Org Name:THE CENTER FOR DENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-862-4993
Mailing Address - Street 1:15 SPRINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7400
Mailing Address - Country:US
Mailing Address - Phone:802-985-3500
Mailing Address - Fax:
Practice Address - Street 1:240 STRATTON RD STE 2
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4623
Practice Address - Country:US
Practice Address - Phone:802-775-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental