1922255439 NPI number — DR. MELISSA JOY SPAULDING D.D.S.

Table of content: DR. MELISSA JOY SPAULDING D.D.S. (NPI 1922255439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922255439 NPI number — DR. MELISSA JOY SPAULDING D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPAULDING
Provider First Name:
MELISSA
Provider Middle Name:
JOY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922255439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 WHEATON WAY, SUITE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-3371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-373-2539
Provider Business Mailing Address Fax Number:
360-373-1721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6659 KIMBALL DR
Provider Second Line Business Practice Location Address:
SUITE D 401
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-858-9169
Provider Business Practice Location Address Fax Number:
360-373-1721
Provider Enumeration Date:
08/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE60035265 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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