Provider Demographics
NPI:1053322230
Name:MOECKEL, MELISSA A (DMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:A
Last Name:MOECKEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11A FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2822
Mailing Address - Country:US
Mailing Address - Phone:508-485-0401
Mailing Address - Fax:508-786-5900
Practice Address - Street 1:11A FLORENCE ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2822
Practice Address - Country:US
Practice Address - Phone:508-485-0401
Practice Address - Fax:508-786-5900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98521223G0001X
MA181041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043544694OtherTAX ID