Provider Demographics
NPI:1518302686
Name:MELGAR, JUAN GABRIEL (DENTAL-ORAL ASSIST)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:GABRIEL
Last Name:MELGAR
Suffix:
Gender:M
Credentials:DENTAL-ORAL ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 E 58TH DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1203
Mailing Address - Country:US
Mailing Address - Phone:424-219-8626
Mailing Address - Fax:
Practice Address - Street 1:1443 E 58TH DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1203
Practice Address - Country:US
Practice Address - Phone:424-219-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant