Provider Demographics
NPI:1003954819
Name:MORLEY, MELISSA ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:MORLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 2314
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-2314
Mailing Address - Country:US
Mailing Address - Phone:618-559-6662
Mailing Address - Fax:618-993-8335
Practice Address - Street 1:7562 OLD ROUTE 13
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-7776
Practice Address - Country:US
Practice Address - Phone:618-993-8333
Practice Address - Fax:618-993-8335
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230278091223G0001X
IL019.0248251223G0001X, 122300000X
IN12012574A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-024825Medicaid
IN201382410Medicaid
MO400133490Medicaid