Provider Demographics
NPI:1841427820
Name:GUNN-HALL, MELISSA LUCINDA (RDHAP, RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LUCINDA
Last Name:GUNN-HALL
Suffix:
Gender:F
Credentials:RDHAP, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 15TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3205
Mailing Address - Country:US
Mailing Address - Phone:310-728-9300
Mailing Address - Fax:
Practice Address - Street 1:929 15TH ST
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3205
Practice Address - Country:US
Practice Address - Phone:310-728-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17866124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist