Provider Demographics
NPI:1265641880
Name:MELENDEZ, CARLOS HIRAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:HIRAM
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9854 TAGORE PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7700
Mailing Address - Country:US
Mailing Address - Phone:407-808-6662
Mailing Address - Fax:407-601-7966
Practice Address - Street 1:9854 TAGORE PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7700
Practice Address - Country:US
Practice Address - Phone:407-808-6662
Practice Address - Fax:407-601-7966
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLDN172601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies