Provider Demographics
NPI:1972377091
Name:MORAN, MELINDA RAE (RDH)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:RAE
Last Name:MORAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:RAE
Other - Last Name:JIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1 CUMBERLAND PLACE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-794-5023
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND PLACE
Practice Address - Street 2:SUITE 116
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-974-3018
Practice Address - Fax:207-974-3067
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3961124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist