Provider Demographics
NPI:1811363567
Name:SMILEY, MELISSA (DMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SMILEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MAYFAIR CIR E
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5817
Mailing Address - Country:US
Mailing Address - Phone:727-324-9141
Mailing Address - Fax:
Practice Address - Street 1:2010 E HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-8255
Practice Address - Country:US
Practice Address - Phone:727-324-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist