MEDICARE: DR. MELISSA ANN JOHNDREAU DDS

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	1223G0001X	General Practice Dentistry	6032	WI

General Provider Information

NPI Number	:	1285746917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANN JOHNDREAU DDS

Provider Business Mailing Address
First Line	:	PSC 482 BOX 106
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362
Country	:	US
Telephone Number	:	6457381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3DDENBN/USNDC
Second Line	:	UNIT 38450
City	:	FPO
State	:	AP
Zip	:	96604-8450
Country	:	US
Telephone Number	:	6457381
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/21/2022

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