MEDICARE: DR. MELISSA ANN BURNETT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019027688	IL

General Provider Information

NPI Number	:	1801059100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANN BURNETT DMD

Provider Business Mailing Address
First Line	:	3737 E US ROUTE 36
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 E US ROUTE 36
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5085
Country	:	US
Telephone Number	:	217-423-2400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	02/26/2024

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