Provider Demographics
NPI:1407935794
Name:MELUGIN, MICHAEL BLAIR (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAIR
Last Name:MELUGIN
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:20855 WATERTOWN RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:262-798-1421
Mailing Address - Fax:262-798-1494
Practice Address - Street 1:20855 WATERTOWN RD
Practice Address - Street 2:SUITE 240
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-798-1421
Practice Address - Fax:262-798-1494
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI45851223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics