Individual
MELISSA ANNE GLEASON TRIMBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
520 HANDEYSIDE LN STE 4, FORT ATKINSON, WI 53538
(920) 563-4372
(920) 563-4374
Mailing address
W9657 IVAN ST, CAMBRIDGE, WI 53523-9021
(715) 894-1217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001755-15
WI
122300000X
Dentist
DEN-DEN-LIC-11460
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912355314
—
WI
Enumeration date
05/26/2016
Last updated
04/26/2019
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