Provider Demographics
NPI:1316955008
Name:HICKEY, MELINDA EISERLOH (DDS)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:EISERLOH
Last Name:HICKEY
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 1:198 HWY 21
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:985-845-0452
Mailing Address - Fax:985-845-2994
Practice Address - Street 1:198 HWY 21
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-845-0452
Practice Address - Fax:985-845-2994
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice