Provider Demographics
NPI:1801057005
Name:JENTZ-COTE, MELISSA L (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:JENTZ-COTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 WILLIAMSBURG AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134
Mailing Address - Country:US
Mailing Address - Phone:630-262-1055
Mailing Address - Fax:630-262-1033
Practice Address - Street 1:2631 WILLIAMSBURG AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134
Practice Address - Country:US
Practice Address - Phone:630-262-1055
Practice Address - Fax:630-262-1033
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190255871223G0001X
IL019-025587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice