Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 165 | AK |
N | 1223P0300X | Periodontist | 8427 | KY |
NPI | 1053550400 |
---|---|
Provider Name | Dr. Melissa Marcella Webster |
First Address | Fairbanks, AK 99701-3506 |
Second Address | Fairbanks, AK 99701-3506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2009 |
Last Update Date | 17/11/2009 |