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General NPI Number Information
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NPI Number | 1558025247
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Entity Type | Organization
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Legal Business Name | MELISSA TRICAMO DDS MS PA
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Dates
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Enumeration Date | 10/28/2021
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 3901 LONG PRAIRIE RD STE 110
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2003
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Country | US
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Telephone | 972-884-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 GOLDWOOD LN
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City | FRISCO
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State | TX
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Zip | 75036-8157
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Country | US
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Telephone | 214-293-8577
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. NEIL DEAN
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Credential | DDS
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Telephone | 214-293-8577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 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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