Provider Demographics
NPI:1093832438
Name:MELANDER, PHILIP GREGG (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GREGG
Last Name:MELANDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 LIBERTY ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2260
Mailing Address - Country:US
Mailing Address - Phone:510-235-1091
Mailing Address - Fax:
Practice Address - Street 1:265 16TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3214
Practice Address - Country:US
Practice Address - Phone:510-233-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice