Provider Demographics
NPI:1912355314
Name:TRIMBELL, MELISSA ANNE GLEASON (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE GLEASON
Last Name:TRIMBELL
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:W9657 IVAN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9021
Mailing Address - Country:US
Mailing Address - Phone:715-894-1217
Mailing Address - Fax:
Practice Address - Street 1:520 HANDEYSIDE LN STE 4
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538
Practice Address - Country:US
Practice Address - Phone:920-563-4372
Practice Address - Fax:920-563-4374
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-11460122300000X
WI1001755-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912355314Medicaid