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General NPI Number Information
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NPI Number | 1801897848
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Entity Type | Individual
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Provider Name | MISTY V MELILLO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 7501 BAY PORT RD
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City | ORLANDO
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State | FL
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Zip | 32819-5502
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Country | US
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Telephone | 407-955-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 7512 DR PHILLIPS BLVD SUITE 50-603
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City | ORLANDO
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State | FL
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Zip | 32819-5131
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Country | US
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Telephone | 407-504-8750
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21623
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License Number State | FL
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