Provider Demographics
NPI:1114053832
Name:POZNANSKI, MELODY ANN
Entity Type:Individual
Prefix:MISS
First Name:MELODY
Middle Name:ANN
Last Name:POZNANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 NW 3RD TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-6946
Mailing Address - Country:US
Mailing Address - Phone:239-872-4119
Mailing Address - Fax:
Practice Address - Street 1:15650 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2569
Practice Address - Country:US
Practice Address - Phone:239-489-1118
Practice Address - Fax:239-489-3627
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH11855124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist