Provider Demographics
NPI:1003047309
Name:FALLON, MELISSA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:FALLON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:WARHOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 COST AVE.
Mailing Address - Street 2:
Mailing Address - City:STONEWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:304-624-5250
Mailing Address - Fax:304-624-5251
Practice Address - Street 1:403 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2748
Practice Address - Country:US
Practice Address - Phone:304-366-3910
Practice Address - Fax:304-366-5539
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054497-1122300000X
WV3928122300000X
WVWV3928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist