Provider Demographics
NPI:1639121031
Name:DENNISON, WILLIAM LANDON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LANDON
Last Name:DENNISON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-0138
Mailing Address - Country:US
Mailing Address - Phone:802-482-2797
Mailing Address - Fax:
Practice Address - Street 1:368 DORSET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:S BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6212
Practice Address - Country:US
Practice Address - Phone:802-864-0192
Practice Address - Fax:802-960-4919
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420003901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEVT6189Medicare ID - Type Unspecified
D78635Medicare UPIN