Provider Demographics
NPI:1710041330
Name:BREIDENTHAL, MELANIE ROSEANN (RDH BS)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ROSEANN
Last Name:BREIDENTHAL
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9462
Mailing Address - Country:US
Mailing Address - Phone:541-772-2593
Mailing Address - Fax:541-772-2593
Practice Address - Street 1:4505 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9462
Practice Address - Country:US
Practice Address - Phone:541-772-2593
Practice Address - Fax:541-772-2593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3413124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist