Provider Demographics
NPI:1447552823
Name:POPP, MELISSA MARIE (RDH, CDHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:POPP
Suffix:
Gender:F
Credentials:RDH, CDHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6180 STATE HIGHWAY 180
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-9693
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N18775 SAULD ST
Practice Address - Street 2:
Practice Address - City:PEMBINE
Practice Address - State:WI
Practice Address - Zip Code:54156-9480
Practice Address - Country:US
Practice Address - Phone:715-324-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5433124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist