Provider Demographics
NPI:1134604259
Name:FORSYTHE, MELISSA (RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FORSYTHE
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 1:18575 E SARATOGA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3223
Mailing Address - Country:US
Mailing Address - Phone:706-464-4913
Mailing Address - Fax:
Practice Address - Street 1:18575 E SARATOGA PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-3223
Practice Address - Country:US
Practice Address - Phone:706-464-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH043110124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist