Provider Demographics
NPI:1164705992
Name:MELISA A CHRISTIAN DDS, PA
Entity Type:Organization
Organization Name:MELISA A CHRISTIAN DDS, PA
Other - Org Name:TRAVIS WALK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-522-4330
Mailing Address - Street 1:4514 TRAVIS ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4112
Mailing Address - Country:US
Mailing Address - Phone:214-522-4330
Mailing Address - Fax:214-522-2283
Practice Address - Street 1:4514 TRAVIS ST
Practice Address - Street 2:SUITE 117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4112
Practice Address - Country:US
Practice Address - Phone:214-522-4330
Practice Address - Fax:214-522-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty