=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932062387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELANIE HAIRSTON, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 692 HANES MALL BLVD
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-5670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-340-6876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1454 WAVERLY ST
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27127-5944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-340-6876
-----------------------------------------------------
Fax | 336-340-6876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ CEO
-----------------------------------------------------
Name | DR. MELANIE HAIRSTON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 336-340-6876
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------