Provider Demographics
NPI:1396738811
Name:EVANGELISTA, MELANIE DE MESA (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:DE MESA
Last Name:EVANGELISTA
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 1:5644 MAGNOLIA RUN CIR
Mailing Address - Street 2:#203
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1584
Mailing Address - Country:US
Mailing Address - Phone:757-479-0220
Mailing Address - Fax:
Practice Address - Street 1:CVN USS ENTERPRISE DENTAL DEPT
Practice Address - Street 2:BOX 48
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23501
Practice Address - Country:US
Practice Address - Phone:757-534-1319
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51472122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist