Individual
MELISSA DEROUSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(573) 438-9355
Mailing address
1 SOUTHTOWNE DR, POTOSI, MO 63664-5729
(573) 438-9355
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2004003161
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004003161
LICENSE
MO
Enumeration date
09/22/2009
Last updated
09/22/2009
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