Provider Demographics
NPI:1346723293
Name:PITTS, MELISSA A (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:PITTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:134 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-2347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2347
Practice Address - Country:US
Practice Address - Phone:715-723-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4505-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist