Provider Demographics
NPI:1598926305
Name:HAIRSTON, MELANIE MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:MICHELLE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:HAIRSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2621 NEW WALKERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-1948
Mailing Address - Country:US
Mailing Address - Phone:336-724-5054
Mailing Address - Fax:336-724-5033
Practice Address - Street 1:2621 NEW WALKERTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1948
Practice Address - Country:US
Practice Address - Phone:336-724-5054
Practice Address - Fax:336-724-5033
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice