Individual
DR. MELISSA LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 656-0044
Mailing address
320 E. ARMSTRONG AVE, PEORIA, IL 61603
(847) 530-8975
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002038
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002038-15
LICENSE
WI
01
—
123456789
DENTIST
—
Enumeration date
06/14/2017
Last updated
02/11/2020
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