Provider Demographics
NPI:1407372980
Name:LASS, MELISSA (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LASS
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 1:1560 3RD ST APT 403
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2306
Mailing Address - Country:US
Mailing Address - Phone:917-969-7172
Mailing Address - Fax:
Practice Address - Street 1:2660 5TH ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6577
Practice Address - Country:US
Practice Address - Phone:510-384-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist