Provider Demographics
NPI:1235322389
Name:MAEDA, MELVIN GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:GERALD
Last Name:MAEDA
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 1:3811 FLORIN RD
Mailing Address - Street 2:#8
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823
Mailing Address - Country:US
Mailing Address - Phone:916-392-7020
Mailing Address - Fax:916-392-7048
Practice Address - Street 1:3811 FLORIN RD
Practice Address - Street 2:#8
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-392-7020
Practice Address - Fax:916-392-7048
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist