Provider Demographics
NPI:1326447871
Name:MELANIE RUTH CASEY, PLLC
Entity Type:Organization
Organization Name:MELANIE RUTH CASEY, PLLC
Other - Org Name:AVERY'S CREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-622-1508
Mailing Address - Street 1:1748 BREVARD RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9658
Mailing Address - Country:US
Mailing Address - Phone:828-676-2114
Mailing Address - Fax:828-676-3231
Practice Address - Street 1:1748 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9658
Practice Address - Country:US
Practice Address - Phone:828-676-2114
Practice Address - Fax:828-676-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811285497Medicaid