Provider Demographics
NPI:1568649994
Name:DUSTON, MELISSA MAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MAE
Last Name:DUSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 WOOD THRUSH DR
Mailing Address - Street 2:#323
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-2620
Mailing Address - Country:US
Mailing Address - Phone:603-762-3410
Mailing Address - Fax:
Practice Address - Street 1:19001 N TAMIAMI TRL
Practice Address - Street 2:#4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7306
Practice Address - Country:US
Practice Address - Phone:239-731-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice