Provider Demographics
NPI:1205805504
Name:KINDELL, MELISSA D (DMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:KINDELL
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 1:2029 US HIGHWAY 441 N
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1901
Mailing Address - Country:US
Mailing Address - Phone:863-357-7338
Mailing Address - Fax:863-357-7342
Practice Address - Street 1:2029 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1901
Practice Address - Country:US
Practice Address - Phone:863-357-7338
Practice Address - Fax:863-357-7342
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63166OtherBCBS PROVIDER #