Provider Demographics
NPI:1316949670
Name:WELTY, MELISSA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LYNN
Last Name:WELTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:CASTRONOVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6531 FM 2920 RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:832-717-0595
Mailing Address - Fax:832-717-0105
Practice Address - Street 1:6531 FM 2920 RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:832-717-0595
Practice Address - Fax:832-717-0105
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2016-05-18
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TX194551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice