Provider Demographics
NPI:1417982141
Name:HACKER, MELINDA HALL (DDS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:HALL
Last Name:HACKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:HALL HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:710 AVE E
Practice Address - Street 2:
Practice Address - City:CARRIZOZO
Practice Address - State:NM
Practice Address - Zip Code:88301-0008
Practice Address - Country:US
Practice Address - Phone:575-648-2839
Practice Address - Fax:505-648-4113
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGMedicaid
NMPENDINGMedicaid