Provider Demographics
NPI:1922791409
Name:CHRISMAN, MELISSA RAE (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAE
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RAE
Other - Last Name:ELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:39 NW HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9535
Mailing Address - Country:US
Mailing Address - Phone:919-584-1844
Mailing Address - Fax:
Practice Address - Street 1:605 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4535
Practice Address - Country:US
Practice Address - Phone:580-442-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist