Provider Demographics
NPI:1538453246
Name:UTLEY, MELISSA R (RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:UTLEY
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 1:635 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1624
Mailing Address - Country:US
Mailing Address - Phone:406-861-7663
Mailing Address - Fax:
Practice Address - Street 1:635 YELLOWSTONE AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1624
Practice Address - Country:US
Practice Address - Phone:406-861-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1216124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist