Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7600 | CO |
NPI | 1407855117 |
---|---|
Provider Name | Dr. Melissa Ann Musolf |
First Address | Colorado Springs, CO 80919-2488 |
Second Address | Colorado Springs, CO 80922-3575 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 08/07/2007 |