MEDICARE: MELISSA ANN BARBARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH3009	NM

General Provider Information

NPI Number	:	1043581705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN BARBARA

Provider Business Mailing Address
First Line	:	3500 TRINITY DR STE B1
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 TRINITY DR STE B1
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2221
Country	:	US
Telephone Number	:	505-662-3163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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