Provider Demographics
NPI:1033454962
Name:DRENNON, MELISSA RAE (RDH)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:RAE
Last Name:DRENNON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 HARMONY HEIGHTS LN
Mailing Address - Street 2:301
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-6245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1845 HARMONY HEIGHTS LN
Practice Address - Street 2:301
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-6245
Practice Address - Country:US
Practice Address - Phone:706-366-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH011154124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist