Provider Demographics
NPI:1588853428
Name:SMITH, MELISSA DEON (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DEON
Last Name:SMITH
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 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-828-2873
Practice Address - Street 1:1115 WEBER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4124
Practice Address - Country:US
Practice Address - Phone:337-828-2550
Practice Address - Fax:337-828-2873
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1858706Medicaid
LA1858706Medicaid