Provider Demographics
NPI:1275026288
Name:PERSCHKE, MELISSA SUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:PERSCHKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 ZABEL DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-3940
Mailing Address - Country:US
Mailing Address - Phone:316-619-2798
Mailing Address - Fax:
Practice Address - Street 1:1610 PROVIDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707
Practice Address - Country:US
Practice Address - Phone:254-313-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist