Provider Demographics
NPI:1962746164
Name:SMITH, MELISSA M (DVM)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 FATHER HERMAN ST
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6554
Mailing Address - Country:US
Mailing Address - Phone:252-619-1833
Mailing Address - Fax:
Practice Address - Street 1:1914 MILL BAY RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6631
Practice Address - Country:US
Practice Address - Phone:907-486-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK684174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian