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General NPI Number Information
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NPI Number | 1356257109
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Entity Type | Organization
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Legal Business Name | MELISSA BLAKE DMD, PLLC (DBA EVERLASTING LIGHT PEDIATRIC DENTISTRY)
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 2970 MEARNS CASTLE DRIVE SUITE 101
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City | GREENSBORO
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State | NC
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Zip | 27405
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Country | US
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Telephone | 336-364-5223
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Fax |
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Provider Business Mailing Address
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Address Line | 2970 MEARNS CASTLE DRIVE SUITE 101
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City | GREENSBORO
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State | NC
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Zip | 27405
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Country | US
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Telephone | 774-251-1137
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | MELISSA BLAKE
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Credential | DMD
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Telephone | 336-364-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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