Provider Demographics
NPI:1497733588
Name:CONGDON, MELESSIA M (RDH)
Entity Type:Individual
Prefix:MS
First Name:MELESSIA
Middle Name:M
Last Name:CONGDON
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 1:500 PARK ST
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1982
Mailing Address - Country:US
Mailing Address - Phone:570-383-9066
Mailing Address - Fax:570-383-4183
Practice Address - Street 1:500 PARK ST
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1982
Practice Address - Country:US
Practice Address - Phone:570-383-9066
Practice Address - Fax:570-383-4183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068160124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist