Provider Demographics
NPI:1962764068
Name:GOODPASTER, MELISSA ANN (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:GOODPASTER
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 1:1982 NEWLAND CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1444
Mailing Address - Country:US
Mailing Address - Phone:208-310-6288
Mailing Address - Fax:
Practice Address - Street 1:10442 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6070
Practice Address - Country:US
Practice Address - Phone:303-410-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN107381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice