Provider Demographics
NPI:1689911273
Name:FLANAGAN, MELINDA R (RDH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:R
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 EISENHOWER DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3781
Mailing Address - Country:US
Mailing Address - Phone:503-302-6544
Mailing Address - Fax:
Practice Address - Street 1:850 EISENHOWER DR NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3781
Practice Address - Country:US
Practice Address - Phone:503-302-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4397124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist