Provider Demographics
NPI:1528686698
Name:MURBACH, MELISSA KIMBERLY (RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KIMBERLY
Last Name:MURBACH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KIMBERLY
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2816 NORTHWING DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-8622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-5603
Practice Address - Country:US
Practice Address - Phone:573-336-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11980124Q00000X
MO2018026831124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist