Provider Demographics
NPI:1578720892
Name:MELISSA C. DAVIDIAN, DDS/DAVIDIAN FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:MELISSA C. DAVIDIAN, DDS/DAVIDIAN FAMILY AND COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-562-2345
Mailing Address - Street 1:12740 SPRUCE TREE WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8295
Mailing Address - Country:US
Mailing Address - Phone:919-562-2345
Mailing Address - Fax:919-562-2365
Practice Address - Street 1:12740 SPRUCE TREE WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8295
Practice Address - Country:US
Practice Address - Phone:919-562-2345
Practice Address - Fax:919-562-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1215088133OtherINDIVIDUAL IPN #