Provider Demographics
NPI:1578124616
Name:MASSETTI, MELISSA (RDHAP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MASSETTI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 N DURANT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1360
Mailing Address - Country:US
Mailing Address - Phone:559-824-0585
Mailing Address - Fax:
Practice Address - Street 1:6708 N DURANT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1360
Practice Address - Country:US
Practice Address - Phone:559-824-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA815125K00000X, 125K00000X
CA27018124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty