=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770138604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELANIE D. EMERSON, DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2019
-----------------------------------------------------
Last Update Date | 08/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9708 E RENO AVE
-----------------------------------------------------
City | MIDWEST CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73130-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-732-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9708 E RENO AVE
-----------------------------------------------------
City | MIDWEST CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73130-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-732-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LINDSEY SHUCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-732-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------