Provider Demographics
NPI:1518408913
Name:FAULKNER, MELISSA MARGARET (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARGARET
Last Name:FAULKNER
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 1:405 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-4351
Mailing Address - Country:US
Mailing Address - Phone:636-797-8045
Mailing Address - Fax:
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-4351
Practice Address - Country:US
Practice Address - Phone:636-797-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005334124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016005334Medicaid