Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 71823-20 | WI |
N | 208D00000X | General Practice Physician | 71823-20 | WI |
NPI | 1023512191 |
---|---|
Provider Name | Dr. Melissa Dodds |
First Address | Verona, WI 53593-9365 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 29/06/2020 |