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General NPI Number Information
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NPI Number | 1457400756
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Entity Type | Individual
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Provider Name | MELANIE WILSON HARTMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5212 B LYNGATE COURT
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-978-5660
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Fax | 703-978-0423
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Provider Business Mailing Address
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Address Line | 5212 B LYNGATE COURT
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-978-5660
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Fax | 703-978-0423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401410329
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License Number State | VA
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