Provider Demographics
NPI:1033237086
Name:KENFIELD, MELISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:KENFIELD
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 1:77 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1513
Mailing Address - Country:US
Mailing Address - Phone:812-829-4886
Mailing Address - Fax:219-769-1493
Practice Address - Street 1:77 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1513
Practice Address - Country:US
Practice Address - Phone:812-829-4886
Practice Address - Fax:219-769-1493
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011101A1223G0001X
CA548081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice