Provider Demographics
NPI:1821239872
Name:GRANT, MELANIE JANELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:JANELLE
Last Name:GRANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:JANELLE
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2164
Mailing Address - Fax:503-526-4418
Practice Address - Street 1:17130 SW UPPER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7004
Practice Address - Country:US
Practice Address - Phone:503-952-2100
Practice Address - Fax:503-624-8732
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist