Provider Demographics
NPI:1992139091
Name:SANTILLI, MELISSA
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 US HIGHWAY 380
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CROSS ROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:940-228-2250
Mailing Address - Fax:
Practice Address - Street 1:11350 US HIGHWAY 380 SUITE 140
Practice Address - Street 2:
Practice Address - City:CROSS ROADS
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-228-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist