=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942059613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2024
-----------------------------------------------------
Last Update Date | 05/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3041 WASHINGTON DR
-----------------------------------------------------
City | MELISSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75454-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-505-3055
-----------------------------------------------------
Fax | 469-299-9976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13466 ALLENWOOD AVE
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75035-7853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-890-6041
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. NASTASSIA ULASIK
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 925-890-6041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------