Provider Demographics
NPI:1548930928
Name:SIMPSON, MELISSA CATHERINE (BASDH, RDH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:BASDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-2058
Mailing Address - Country:US
Mailing Address - Phone:253-670-1266
Mailing Address - Fax:
Practice Address - Street 1:37418 51ST AVE S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-9470
Practice Address - Country:US
Practice Address - Phone:253-670-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WADH00007049124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist