Provider Demographics
NPI:1366338410
Name:BLANCO, MELISSA (DDS)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E LARAMIE DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-2251
Mailing Address - Country:US
Mailing Address - Phone:919-889-0654
Mailing Address - Fax:
Practice Address - Street 1:6307 BURLINGTON RD STE N
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9262
Practice Address - Country:US
Practice Address - Phone:336-901-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC141841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice