Healthcare Provider Details

I. General information

NPI: 1588280341
Provider Name (Legal Business Name): MELISSA HOHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 ACACIA DR S
UVALDE TX
78801-1164
US

IV. Provider business mailing address

361 ACACIA DR S
UVALDE TX
78801-1164
US

V. Phone/Fax

Practice location:
  • Phone: 830-275-0063
  • Fax:
Mailing address:
  • Phone: 830-275-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number17369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: