Individual
MELISSA MAE MOUTRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD DDS
Contact information
Practice address
311 CAMPUS DRIVE, SUITE 101, GARDEN CITY, KS 67846
(602) 272-0100
(620) 271-0160
Mailing address
311 CAMPUS DRIVE, SUITE 101, GARDEN CITY, KS 67846
(602) 272-0100
(620) 271-0160
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
04-41292
KS
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D1107
SD
Other
Enumeration date
05/25/2010
Last updated
07/15/2021
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