Provider Demographics
NPI:1851879274
Name:FLEASE, MELISSA A (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FLEASE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 W GRANDE MARKET DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8442
Mailing Address - Country:US
Mailing Address - Phone:920-731-7445
Mailing Address - Fax:920-882-2946
Practice Address - Street 1:825 W FULTON ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1471
Practice Address - Country:US
Practice Address - Phone:920-731-7445
Practice Address - Fax:920-882-2946
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI569016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist