Healthcare Provider Details

I. General information

NPI: 1447433396
Provider Name (Legal Business Name): MELANIE DAWSON COLBERT R.D.H. BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30704 HUNTSMAN DR E
FARMINGTON HILLS MI
48331-1378
US

IV. Provider business mailing address

30704 HUNTSMAN DR E
FARMINGTON HILLS MI
48331-1378
US

V. Phone/Fax

Practice location:
  • Phone: 313-244-3498
  • Fax:
Mailing address:
  • Phone: 313-244-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902003708
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: