Provider Demographics
NPI:1396881611
Name:SMITH, MELISSA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1111 E. SIXTH STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090
Mailing Address - Country:US
Mailing Address - Phone:636-239-6328
Mailing Address - Fax:636-239-5048
Practice Address - Street 1:1111 E. SIXTH STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090
Practice Address - Country:US
Practice Address - Phone:636-239-6328
Practice Address - Fax:636-239-5048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040132541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice