Healthcare Provider Details

I. General information

NPI: 1407855117
Provider Name (Legal Business Name): MELISSA ANN MUSOLF DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 TUTT BLVD SUITE 150
COLORADO SPRINGS CO
80922-3575
US

IV. Provider business mailing address

5735 ASTORIA WAY
COLORADO SPRINGS CO
80919-2488
US

V. Phone/Fax

Practice location:
  • Phone: 719-622-9200
  • Fax: 719-622-9201
Mailing address:
  • Phone: 719-264-6166
  • Fax: 719-622-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7600
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: