Provider Demographics
NPI:1104584986
Name:MELISSA MERTELY, PLLC
Entity type:Organization
Organization Name:MELISSA MERTELY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MERTELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-496-3297
Mailing Address - Street 1:315 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8209
Mailing Address - Country:US
Mailing Address - Phone:813-495-3297
Mailing Address - Fax:
Practice Address - Street 1:315 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8209
Practice Address - Country:US
Practice Address - Phone:252-522-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental