Basic Information
| Provider Information | |||||||||
| NPI: | 1639121031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNISON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LANDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 138 | ||||||||
| Address2: | |||||||||
| City: | HINESBURG | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054610138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024822797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 368 DORSET ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | S BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028640192 | ||||||||
| FaxNumber: | 8029604919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 09/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0420003901 | VT | Y | Other Service Providers | Specialist |
No ID Information.