Provider Demographics
NPI:1811523582
Name:WARD, MELANIE ANN (RDH)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:WARD
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 1:209 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2919
Mailing Address - Country:US
Mailing Address - Phone:865-740-9062
Mailing Address - Fax:
Practice Address - Street 1:305 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-2206
Practice Address - Country:US
Practice Address - Phone:865-426-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN003366124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist