Provider Demographics
NPI:1295158434
Name:ABBOTT, MELISSA (RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ABBOTT
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 1:9810 PORTLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:OR
Mailing Address - Zip Code:97305-9222
Mailing Address - Country:US
Mailing Address - Phone:503-910-8572
Mailing Address - Fax:
Practice Address - Street 1:9810 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:OR
Practice Address - Zip Code:97305-9222
Practice Address - Country:US
Practice Address - Phone:503-910-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6553124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist