Provider Demographics
NPI:1164510806
Name:MELEMSETER, LORI LARSEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LARSEN
Last Name:MELEMSETER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3520 S SHELDON LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6121
Mailing Address - Country:US
Mailing Address - Phone:605-338-3577
Mailing Address - Fax:605-338-5082
Practice Address - Street 1:3520 S SHELDON LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6121
Practice Address - Country:US
Practice Address - Phone:605-338-3577
Practice Address - Fax:605-338-5082
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice