Provider Demographics
NPI:1467661371
Name:GIERMAN, MELISSA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:E
Last Name:GIERMAN
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 1:430 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-627-8601
Mailing Address - Fax:630-627-0055
Practice Address - Street 1:430 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2600
Practice Address - Country:US
Practice Address - Phone:630-627-8601
Practice Address - Fax:630-627-0055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025868122300000X
IL019.0258681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice