Provider Demographics
NPI:1548867161
Name:GARBO, MELISSA ELAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ELAINE
Last Name:GARBO
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 1:114 RABON CHASE CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-8633
Mailing Address - Country:US
Mailing Address - Phone:864-991-7900
Mailing Address - Fax:
Practice Address - Street 1:1617 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3791
Practice Address - Country:US
Practice Address - Phone:864-859-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice