Provider Demographics
NPI:1912550666
Name:WOMACHKA, MELANIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:WOMACHKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:THARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1405
Mailing Address - Country:US
Mailing Address - Phone:319-627-2328
Mailing Address - Fax:
Practice Address - Street 1:101 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52776-1405
Practice Address - Country:US
Practice Address - Phone:319-627-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice