Provider Demographics
NPI:1447433396
Name:COLBERT, MELANIE DAWSON (RDH BS)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWSON
Last Name:COLBERT
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30704 HUNTSMAN DR E
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1378
Mailing Address - Country:US
Mailing Address - Phone:313-244-3498
Mailing Address - Fax:
Practice Address - Street 1:30704 HUNTSMAN DR E
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1378
Practice Address - Country:US
Practice Address - Phone:313-244-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902003708124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447433396Medicaid