Provider Demographics
NPI:1033550561
Name:KEMINK, MELISSA GAIL MAGSIPOC (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL MAGSIPOC
Last Name:KEMINK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GAIL
Other - Last Name:MAGSIPOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:140 DAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6413
Mailing Address - Country:US
Mailing Address - Phone:865-215-5000
Mailing Address - Fax:
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN97241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1534039Medicaid