Provider Demographics
NPI:1164801874
Name:RASMUSSEN, MELANIE KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:KAY
Last Name:RASMUSSEN
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 1:9792 HWY 70
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8747
Mailing Address - Country:US
Mailing Address - Phone:715-358-9994
Mailing Address - Fax:
Practice Address - Street 1:9758 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9754
Practice Address - Country:US
Practice Address - Phone:715-356-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001076-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist