Provider Demographics
NPI:1750637443
Name:SQUITERI, MELANIE DENISE (RN, RDH)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DENISE
Last Name:SQUITERI
Suffix:
Gender:F
Credentials:RN, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S RANCHO DR
Mailing Address - Street 2:270
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-636-3060
Mailing Address - Fax:702-636-3057
Practice Address - Street 1:901 S RANCHO DR
Practice Address - Street 2:270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3801
Practice Address - Country:US
Practice Address - Phone:702-636-3060
Practice Address - Fax:702-636-3057
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11068124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist