Provider Demographics
NPI:1801897848
Name:MELILLO, MISTY V (DMD)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:V
Last Name:MELILLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:SIDOTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7512 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 50-603
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5131
Mailing Address - Country:US
Mailing Address - Phone:407-504-8750
Mailing Address - Fax:
Practice Address - Street 1:7501 BAY PORT RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5502
Practice Address - Country:US
Practice Address - Phone:407-955-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21623122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist