Provider Demographics
NPI:1114299138
Name:ZETTLER, MELISSA S (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:ZETTLER
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 1:14127 VERNON AVE S
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4027
Mailing Address - Country:US
Mailing Address - Phone:952-440-9303
Mailing Address - Fax:952-440-9311
Practice Address - Street 1:14127 VERNON AVE S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4027
Practice Address - Country:US
Practice Address - Phone:952-440-9303
Practice Address - Fax:952-440-9311
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN109541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice