Provider Demographics
NPI:1407290877
Name:DOLE, MELISSA HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:HARRIS
Last Name:DOLE
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 1:110 NUT TREE PKWY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3251
Mailing Address - Country:US
Mailing Address - Phone:707-451-8390
Mailing Address - Fax:
Practice Address - Street 1:110 NUT TREE PKWY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3251
Practice Address - Country:US
Practice Address - Phone:707-451-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63868122300000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist