MEDICARE: MELISSA LADD EPDH

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	H5670	OR

General Provider Information

NPI Number	:	1043925118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LADD EPDH

Provider Business Mailing Address
First Line	:	1275 S RIVER RD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-3906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 S RIVER RD
Second Line	:
City	:	COTTAGE GROVE
State	:	OR
Zip	:	97424-3906
Country	:	US
Telephone Number	:	541-942-3383
Fax Number	:

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

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	02/14/2023

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