Provider Demographics
NPI:1598894925
Name:ROSENBERGER, MELINDA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MARIE
Last Name:ROSENBERGER
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:E5260 INTERLACHEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-9444
Mailing Address - Country:US
Mailing Address - Phone:715-878-9468
Mailing Address - Fax:
Practice Address - Street 1:2302 HENDRICKSON DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6185
Practice Address - Country:US
Practice Address - Phone:715-836-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice