Provider Demographics
NPI:1285630608
Name:GERKE, MELISSA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:GERKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:GERKE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2448 BECKER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5714
Mailing Address - Country:US
Mailing Address - Phone:979-836-0590
Mailing Address - Fax:
Practice Address - Street 1:2448 BECKER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5714
Practice Address - Country:US
Practice Address - Phone:979-836-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist