Provider Demographics
NPI:1538300207
Name:DR. MELISSA J HOUSE DDS PA
Entity type:Organization
Organization Name:DR. MELISSA J HOUSE DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-260-6868
Mailing Address - Street 1:1615 E 61ST ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1964
Mailing Address - Country:US
Mailing Address - Phone:316-260-6868
Mailing Address - Fax:316-260-6830
Practice Address - Street 1:1615 E 61ST ST N STE 300
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1964
Practice Address - Country:US
Practice Address - Phone:316-260-6868
Practice Address - Fax:316-260-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS604131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty