Healthcare Provider Details

I. General information

NPI: 1740982248
Provider Name (Legal Business Name): MELISSA ESQUIVEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E HIGHWAY 114 STE 200
ROANOKE TX
76262-6713
US

IV. Provider business mailing address

4626 SPRUCE ST
FLOWER MOUND TX
75028-1762
US

V. Phone/Fax

Practice location:
  • Phone: 972-821-1374
  • Fax:
Mailing address:
  • Phone: 972-821-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number39749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: