Provider Demographics
NPI:1376893511
Name:PARRA, MELISSA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:PARRA
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 1:6610 N 93RD AVE
Mailing Address - Street 2:APT 1056
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3170
Mailing Address - Country:US
Mailing Address - Phone:650-773-6911
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD.
Practice Address - Street 2:56TH MEDICAL GROUP
Practice Address - City:LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309-1525
Practice Address - Country:US
Practice Address - Phone:623-856-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist