Provider Demographics
NPI:1922425982
Name:BALK-ELLIOTT, MELISSA ALICE (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ALICE
Last Name:BALK-ELLIOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ALICE
Other - Last Name:BALK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6710 SPRING STUEBNER RD. STE 700
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:281-204-2320
Mailing Address - Fax:281-547-7342
Practice Address - Street 1:6710 SPRING STUEBNER RD. STE 700
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389
Practice Address - Country:US
Practice Address - Phone:281-204-2320
Practice Address - Fax:281-547-7342
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324461223P0221X
PADS039872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist