Provider Demographics
NPI:1639574916
Name:KERBER, MELISSA SHAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SHAH
Last Name:KERBER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:HARISH
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2015 INTERSTATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-203-2740
Mailing Address - Fax:
Practice Address - Street 1:2015 INTERSTATE DRIVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-203-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025730001223G0001X, 390200000X
ALD6228-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program