Provider Demographics
NPI:1497373880
Name:WILLOCKS, MELINDA LOU (RDH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LOU
Last Name:WILLOCKS
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 1:1930 ALCOA HWY STE 340
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1585
Mailing Address - Country:US
Mailing Address - Phone:865-305-9440
Mailing Address - Fax:865-305-9442
Practice Address - Street 1:1930 ALCOA HWY STE 340
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1585
Practice Address - Country:US
Practice Address - Phone:865-305-9440
Practice Address - Fax:865-305-9442
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH819124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist