Provider Demographics
NPI:1417961723
Name:MELAZZO, LEON FRANK (DMD)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:FRANK
Last Name:MELAZZO
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 1:4516 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4635
Mailing Address - Country:US
Mailing Address - Phone:205-991-5343
Mailing Address - Fax:205-991-7548
Practice Address - Street 1:4516 VALLEYDALE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4635
Practice Address - Country:US
Practice Address - Phone:205-991-5343
Practice Address - Fax:205-991-7548
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90589OtherBLUE CROSS BLUE SHIELD