Healthcare Provider Details

I. General information

NPI: 1922425982
Provider Name (Legal Business Name): MELISSA ALICE BALK-ELLIOTT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA ALICE BALK DDS

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 SPRING STUEBNER RD. STE 700
SPRING TX
77389
US

IV. Provider business mailing address

6710 SPRING STUEBNER RD. STE 700
SPRING TX
77389
US

V. Phone/Fax

Practice location:
  • Phone: 281-204-2320
  • Fax: 281-547-7342
Mailing address:
  • Phone: 281-204-2320
  • Fax: 281-547-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number32446
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039872
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: