Healthcare Provider Details

I. General information

NPI: 1801101696
Provider Name (Legal Business Name): HEATHER MELISSA VANPELT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 FRONTAGE RD N
MACON MS
39341
US

IV. Provider business mailing address

PO BOX 306
MACON MS
39341
US

V. Phone/Fax

Practice location:
  • Phone: 662-726-4344
  • Fax:
Mailing address:
  • Phone: 601-984-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3547-10
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: