MEDICARE: MELISSA MACHALEK RDH

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	5929	TX

General Provider Information

NPI Number	:	1639573900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MACHALEK RDH

Provider Business Mailing Address
First Line	:	2600 S 1ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-7435
Country	:	US
Telephone Number	:	254-298-8657
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S 1ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-7435
Country	:	US
Telephone Number	:	254-298-8657
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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