Provider Demographics
NPI:1639317621
Name:MCKITRICK, MELODY KAY LOWE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:KAY LOWE
Last Name:MCKITRICK
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 1:3 E MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2141
Mailing Address - Country:US
Mailing Address - Phone:405-275-4581
Mailing Address - Fax:
Practice Address - Street 1:3 E MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2141
Practice Address - Country:US
Practice Address - Phone:405-275-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist