Provider Demographics
NPI:1922329473
Name:DAVIS, MELLISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELLISSA
Middle Name:
Last Name:DAVIS
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 1:20290 PARK LAKE VIEW DR APT 1311
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1978
Mailing Address - Country:US
Mailing Address - Phone:512-689-7895
Mailing Address - Fax:
Practice Address - Street 1:20290 PARK LAKE VIEW DR APT 1311
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1978
Practice Address - Country:US
Practice Address - Phone:512-689-7895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253331223G0001X
OH30.0254541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice