| Organization Name: | WILLISTON ROAD FAMILY DENTAL , PLC |
| NPI Number: | 1063786374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN MELO (OWNER/DENTIST) |
| Mailing Address: | 1340 Williston Rd South Burlington |
| State: | VT US |
| Postal Code: | 054036469 |
| Phone Number: | 8028630505 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2012 |
| NPI Last Update Date: | 03/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 0160002103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |