Provider Demographics
NPI:1518317460
Name:CONLEY, MELISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:CONLEY
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 1:1103 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1362
Mailing Address - Country:US
Mailing Address - Phone:248-548-1440
Mailing Address - Fax:
Practice Address - Street 1:1103 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1362
Practice Address - Country:US
Practice Address - Phone:248-548-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist