Provider Demographics
NPI:1215318738
Name:TRUMPP, MELISSA LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNNE
Last Name:TRUMPP
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 1:4 S. BERKLEY STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053
Mailing Address - Country:US
Mailing Address - Phone:913-837-4746
Mailing Address - Fax:
Practice Address - Street 1:4 S. BERKLEY STREET
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053
Practice Address - Country:US
Practice Address - Phone:913-837-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201264690AMedicaid