Provider Demographics
NPI:1841564820
Name:MELISSA KIDS DENTAL, PLLC
Entity Type:Organization
Organization Name:MELISSA KIDS DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:469-422-5437
Mailing Address - Street 1:6513 PRESTON RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2688
Mailing Address - Country:US
Mailing Address - Phone:469-422-5437
Mailing Address - Fax:972-378-6771
Practice Address - Street 1:1711 COOPER ST
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9542
Practice Address - Country:US
Practice Address - Phone:469-422-5437
Practice Address - Fax:972-378-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285094301Medicaid