Provider Demographics
NPI:1154515690
Name:AHREND, MELINDA LEA (DDS)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEA
Last Name:AHREND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LEA
Other - Last Name:BOATWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3707 W 108TH CT
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-1815
Mailing Address - Country:US
Mailing Address - Phone:918-518-6595
Mailing Address - Fax:
Practice Address - Street 1:31870 EAST HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-279-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist