Provider Demographics
NPI:1497901367
Name:MCCOOL, MELISSA ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MCCOOL
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 1:3701 BAKER LN STE 1
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-825-1000
Mailing Address - Fax:775-826-3030
Practice Address - Street 1:3701 BAKER LN STE 1
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-825-1000
Practice Address - Fax:775-826-3030
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry