Healthcare Provider Details

I. General information

NPI: 1689823619
Provider Name (Legal Business Name): MELISSA SIOUX AMUNDSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTERVILLE RD STE 100
TALLAHASSEE FL
32308-4638
US

IV. Provider business mailing address

1401 CENTERVILLE RD STE 100
TALLAHASSEE FL
32308-4638
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-5183
  • Fax: 850-656-1288
Mailing address:
  • Phone: 850-877-5183
  • Fax: 850-656-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN20015
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN20015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: