Provider Demographics
NPI:1174557813
Name:NITTA, MELISSA M (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:NITTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5995 KUAKINI HWY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2144
Mailing Address - Country:US
Mailing Address - Phone:808-329-1715
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:SUITE 121
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2144
Practice Address - Country:US
Practice Address - Phone:808-329-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice