Provider Demographics
NPI:1902421803
Name:MERTELY, MELISSA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MARIE
Last Name:MERTELY
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 1:315 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:252-522-1333
Mailing Address - Fax:252-522-1333
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:252-527-9321
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice