Provider Demographics
NPI:1457612541
Name:NESBITT, MELANIE SHAW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SHAW
Last Name:NESBITT
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 1:3285 HACKS CROSS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8945
Mailing Address - Country:US
Mailing Address - Phone:901-759-0970
Mailing Address - Fax:
Practice Address - Street 1:3285 HACKS CROSS RD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8945
Practice Address - Country:US
Practice Address - Phone:901-759-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019029250122300000X
TNDS0000009624122300000X, 1223E0200X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223E0200XDental ProvidersDentistEndodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1533569Medicaid
TN1533569Medicaid