Provider Demographics
NPI:1407332190
Name:GOULET, MELISSA (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GOULET
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FEDERAL ST STE 240
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2573
Mailing Address - Country:US
Mailing Address - Phone:413-772-0884
Mailing Address - Fax:
Practice Address - Street 1:55 FEDERAL ST STE 240
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2573
Practice Address - Country:US
Practice Address - Phone:413-772-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH89626124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist