Provider Demographics
NPI:1508322793
Name:ALFREDO MELENDEZ
Entity Type:Organization
Organization Name:ALFREDO MELENDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-996-9866
Mailing Address - Street 1:2300 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3963
Mailing Address - Country:US
Mailing Address - Phone:915-996-9866
Mailing Address - Fax:
Practice Address - Street 1:2300 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3963
Practice Address - Country:US
Practice Address - Phone:915-996-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5368350OtherUNITED HEALTH CARE