Provider Demographics
NPI:1407855117
Name:MUSOLF, MELISSA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:MUSOLF
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 1:5735 ASTORIA WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2488
Mailing Address - Country:US
Mailing Address - Phone:719-264-6166
Mailing Address - Fax:719-622-9201
Practice Address - Street 1:6140 TUTT BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3575
Practice Address - Country:US
Practice Address - Phone:719-622-9200
Practice Address - Fax:719-622-9201
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76001223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health