Provider Demographics
NPI:1013492503
Name:HISKEY, MELANIE SHAWN MCDIVITT (DMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SHAWN MCDIVITT
Last Name:HISKEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14124 MAIN ST NE STE C
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8477
Mailing Address - Country:US
Mailing Address - Phone:425-788-7328
Mailing Address - Fax:
Practice Address - Street 1:14124 MAIN ST NE STE C
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8477
Practice Address - Country:US
Practice Address - Phone:425-788-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608585711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice