MEDICARE: MRS. MELANIE DENISE SQUITERI RN, 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	11068	NV

General Provider Information

NPI Number	:	1750637443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE DENISE SQUITERI RN, RDH

Provider Business Mailing Address
First Line	:	901 S RANCHO DR
Second Line	:	270
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-636-3060
Fax Number	:	702-636-3057

Provider Business Practice Location Address
First Line	:	901 S RANCHO DR
Second Line	:	270
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3801
Country	:	US
Telephone Number	:	702-636-3060
Fax Number	:	702-636-3057

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

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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