Provider Demographics
NPI:1790710457
Name:DYMOND, MELISSA LEE (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:DYMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:1825 E WILLOW TREE CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4933
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34.0079022085R0202X
CA20A94042085R0202X
AZ0053842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology