Provider Demographics
NPI:1730645656
Name:DAVIS, MELINDA TENASHA (EPRDH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:TENASHA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EPRDH
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:TENASHA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EPRDH
Mailing Address - Street 1:3354 TALON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7560
Mailing Address - Country:US
Mailing Address - Phone:541-337-0564
Mailing Address - Fax:
Practice Address - Street 1:3354 TALON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7560
Practice Address - Country:US
Practice Address - Phone:541-337-0564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7091124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist