Provider Demographics
NPI:1518240779
Name:RODEN, MELISSA T (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:T
Last Name:RODEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 MISTY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-8688
Mailing Address - Country:US
Mailing Address - Phone:205-508-3403
Mailing Address - Fax:
Practice Address - Street 1:4701 MISTY RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-8688
Practice Address - Country:US
Practice Address - Phone:205-508-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist