=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083932081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA REED ROSSON D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2010
-----------------------------------------------------
Last Update Date | 09/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4358 THOUSAND OAKS DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-241-5166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4358 THOUSAND OAKS DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-241-5166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 24667
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------