Provider Demographics
NPI:1942467394
Name:RESTREPO, MELISSA ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNA
Last Name:RESTREPO
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 1:850 CRAWFORD PKWY
Mailing Address - Street 2:APT 4314
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2304
Mailing Address - Country:US
Mailing Address - Phone:301-974-1457
Mailing Address - Fax:
Practice Address - Street 1:12420 WARWICK BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-595-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice