Provider Demographics
NPI:1053550400
Name:WEBSTER, MELISSA MARCELLA (DMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARCELLA
Last Name:WEBSTER
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 1:421 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3506
Mailing Address - Country:US
Mailing Address - Phone:907-455-7100
Mailing Address - Fax:907-455-7109
Practice Address - Street 1:421 3RD ST
Practice Address - Street 2:STE B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3506
Practice Address - Country:US
Practice Address - Phone:907-455-7100
Practice Address - Fax:907-455-7109
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1651223P0300X
KY84271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics