Individual
MELISSA JANE MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
171 INNER LOOP RD, FORT IRWIN, CA 92310
(999) 999-9999
Mailing address
171 INNER LOOP RD, FORT IRWIN, CA 92310
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
28438
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28384
REGISTERED DENTAL HYGIENE LICENSE
CA
Enumeration date
10/27/2015
Last updated
05/17/2022
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