Provider Demographics
NPI:1124702196
Name:LACOUTURE, MELISSA (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LACOUTURE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 SOUNDINGS CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2048
Mailing Address - Country:US
Mailing Address - Phone:786-234-7351
Mailing Address - Fax:
Practice Address - Street 1:951 SANSBURYS WAY STE 201
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3619
Practice Address - Country:US
Practice Address - Phone:561-660-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN288351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice