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General NPI Number Information
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NPI Number | 1457612541
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Entity Type | Individual
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Provider Name | MELANIE SHAW NESBITT D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 3285 HACKS CROSS RD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38125-8945
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Country | US
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Telephone | 901-759-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 3285 HACKS CROSS RD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38125-8945
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Country | US
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Telephone | 901-759-0970
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029250
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000009624
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS0000009624
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS0000009624
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License Number State | TN
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