Provider Demographics
NPI:1326422783
Name:SJOREN, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SJOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 ROXBURY LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-8855
Mailing Address - Country:US
Mailing Address - Phone:269-267-8332
Mailing Address - Fax:
Practice Address - Street 1:342 ROXBURY LN
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-8855
Practice Address - Country:US
Practice Address - Phone:269-267-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017543124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist