Healthcare Provider Details

I. General information

NPI: 1437487576
Provider Name (Legal Business Name): MELISSA ELAINE REESE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 SOUTH FALLSBURG MAIN STREET
SOUTH FALLSBURG NY
12779
US

IV. Provider business mailing address

PO BOX 2022
SOUTH FALLSBURG NY
12779
US

V. Phone/Fax

Practice location:
  • Phone: 845-434-8444
  • Fax: 845-434-8440
Mailing address:
  • Phone: 845-434-8444
  • Fax: 845-434-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberS-1024732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: