Provider Demographics
NPI:1487702122
Name:ACOSTA, MELANIE ANNE (DMD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 COLD MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6227
Mailing Address - Country:US
Mailing Address - Phone:301-598-4476
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-989-8994
Practice Address - Fax:301-989-0021
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry