Provider Demographics
NPI:1306967161
Name:COLE, MELISSA MOSELEY (DMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MOSELEY
Last Name:COLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-0185
Mailing Address - Country:US
Mailing Address - Phone:601-845-6357
Mailing Address - Fax:
Practice Address - Street 1:2614 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9415
Practice Address - Country:US
Practice Address - Phone:601-845-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3334-05122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09773780Medicaid