MEDICARE: MELANIE ANN WARD 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	003366	TN

General Provider Information

NPI Number	:	1811523582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ANN WARD RDH

Provider Business Mailing Address
First Line	:	209 MEADOW LN
Second Line	:
City	:	LA FOLLETTE
State	:	TN
Zip	:	37766-2919
Country	:	US
Telephone Number	:	865-740-9062
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 S MAIN ST
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2206
Country	:	US
Telephone Number	:	865-426-7421
Fax Number	:

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

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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