Basic Information
| Provider Information | |||||||||
| NPI: | 1598905267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOISVERT | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2747 VT ROUTE 15 E | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 056618644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028882660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HARDWICK | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058430537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024722260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2009 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 015-0001605 | VT | Y | Dental Providers | Dental Hygienist |
No ID Information.