Provider Demographics
NPI:1083932081
Name:ROSSON, MELISSA REED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:REED
Last Name:ROSSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:REED
Other - Last Name:ROSSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4358 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2102
Mailing Address - Country:US
Mailing Address - Phone:210-241-5166
Mailing Address - Fax:
Practice Address - Street 1:4358 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2102
Practice Address - Country:US
Practice Address - Phone:210-241-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist