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General NPI Number Information
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NPI Number | 1609442268
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Entity Type | Individual
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Provider Name | MELISSA PESTLIN
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Gender | Female
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 3575 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4324
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Country | US
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Telephone | 423-458-6660
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Fax | 423-339-2095
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Provider Business Mailing Address
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Address Line | 3575 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4324
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Country | US
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Telephone | 423-458-6660
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Fax | 423-339-2095
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 16971
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License Number State | TN
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