Provider Demographics
NPI:1730225897
Name:NEWBILL, MELANIE R (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:NEWBILL
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 1:12 LENOX PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1902
Mailing Address - Country:US
Mailing Address - Phone:314-461-4076
Mailing Address - Fax:314-569-1522
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6835
Practice Address - Country:US
Practice Address - Phone:314-567-7033
Practice Address - Fax:314-569-1522
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice