Provider Demographics
NPI:1679649719
Name:COPPS, MELISSA J (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:COPPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 COUNTY ROAD PH
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650
Mailing Address - Country:US
Mailing Address - Phone:608-783-7330
Mailing Address - Fax:608-783-5082
Practice Address - Street 1:1202 COUNTY ROAD PH
Practice Address - Street 2:SUITE 300
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650
Practice Address - Country:US
Practice Address - Phone:608-783-7330
Practice Address - Fax:608-783-5082
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice