Healthcare Provider Details

I. General information

NPI: 1801057005
Provider Name (Legal Business Name): MELISSA L. JENTZ-COTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 WILLIAMSBURG AVE. SUITE 201
GENEVA IL
60134
US

IV. Provider business mailing address

2631 WILLIAMSBURG AVE. SUITE 201
GENEVA IL
60134
US

V. Phone/Fax

Practice location:
  • Phone: 630-262-1055
  • Fax: 630-262-1033
Mailing address:
  • Phone: 630-262-1055
  • Fax: 630-262-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-025587
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019025587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: