Provider Demographics
NPI:1710137971
Name:HOUSE, MELISSA JANE (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JANE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:DDS PA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:HANSCHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS PA
Mailing Address - Street 1:1615 E 61ST ST N.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219
Mailing Address - Country:US
Mailing Address - Phone:316-260-6868
Mailing Address - Fax:316-260-6930
Practice Address - Street 1:1615 E 61ST ST N STE 300
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1964
Practice Address - Country:US
Practice Address - Phone:316-260-6868
Practice Address - Fax:316-283-5093
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice