Individual provider Active NPI

Melissa Harris Dole, DDS

  • Dentist
  • Vacaville, CA
National Provider Identifier
1407290877
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63868 Issued in CA
Practice address
110 Nut Tree Pkwy
Vacaville, CA 95687-3251
Phone
(707) 451-8390
NPI assigned
Apr 29, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 63868 CA Primary

Addresses

Primary practice location

110 Nut Tree Pkwy
Vacaville, CA 95687-3251

Mailing address

110 Nut Tree Pkwy
Vacaville, CA 95687-3251
Phone (707) 451-8390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150810002803 CA Order and Referring Only - DentistPractitioner - Dentist 3375858004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
63868CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mantena and Ghazal Dental Corporation PastSince Feb 7, 2021 Accepting new patients
Leng C Hoang DDS Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1407290877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 NUT TREE PKWY",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956873251",
            "telephone_number": "707-451-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 NUT TREE PKWY",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956873251",
            "telephone_number": "707-451-8390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLE",
        "first_name": "MELISSA",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-29",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "63868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vacaville, CA

Sources for this page

Verify at the official NPI Registry.