Provider Demographics
NPI:1659493740
Name:TALBOTT, MELISSA PAMELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:PAMELA
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:PAMELA
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11876 STAPLETON DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8438
Mailing Address - Country:US
Mailing Address - Phone:719-375-0690
Mailing Address - Fax:
Practice Address - Street 1:11876 STAPLETON DR
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:CO
Practice Address - Zip Code:80831-8438
Practice Address - Country:US
Practice Address - Phone:719-375-0690
Practice Address - Fax:719-304-5409
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53838238Medicaid