Provider Demographics
NPI:1396476800
Name:JAVA DENTAL OF MELISSA LLC
Entity type:Organization
Organization Name:JAVA DENTAL OF MELISSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHWAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-363-7331
Mailing Address - Street 1:2435 SAM RAYBURN HWY STE 700
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2825
Mailing Address - Country:US
Mailing Address - Phone:469-663-0214
Mailing Address - Fax:
Practice Address - Street 1:2435 SAM RAYBURN HWY STE 700
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2825
Practice Address - Country:US
Practice Address - Phone:469-663-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty