Provider Demographics
NPI:1689807109
Name:DETWEILER, MELANIE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:C
Last Name:DETWEILER
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 1:3643 SEA BREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4736
Mailing Address - Country:US
Mailing Address - Phone:757-679-8914
Mailing Address - Fax:
Practice Address - Street 1:4530 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6441
Practice Address - Country:US
Practice Address - Phone:757-499-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014124891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice