Provider Demographics
NPI:1043508740
Name:ROSALES, MELISSA MICHELE (RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELE
Last Name:ROSALES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MICHELE
Other - Last Name:COPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:351 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-0000
Mailing Address - Country:US
Mailing Address - Phone:912-767-8513
Mailing Address - Fax:
Practice Address - Street 1:351 W 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-0000
Practice Address - Country:US
Practice Address - Phone:912-767-8513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8075124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist