Provider Demographics
NPI:1740982248
Name:ESQUIVEL, MELISSA (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ESQUIVEL
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 1:4626 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1762
Mailing Address - Country:US
Mailing Address - Phone:972-821-1374
Mailing Address - Fax:
Practice Address - Street 1:860 E HIGHWAY 114 STE 200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6713
Practice Address - Country:US
Practice Address - Phone:972-821-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist