Provider Demographics
NPI:1417387481
Name:WHITCOMB, MELISSA KAY (RDH)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KAY
Last Name:WHITCOMB
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 1:57418 COUNTY ROAD 681
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9421
Mailing Address - Country:US
Mailing Address - Phone:269-621-6159
Mailing Address - Fax:269-621-2725
Practice Address - Street 1:57418 COUNTY ROAD 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9421
Practice Address - Country:US
Practice Address - Phone:269-621-6159
Practice Address - Fax:269-621-2725
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014292124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382715388Medicaid