Provider Demographics
NPI:1528387453
Name:MELENDEZ, PRISCILLA MILAGROS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:MILAGROS
Last Name:MELENDEZ
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:A4 CALLE MARGINAL
Mailing Address - Street 2:COSTA DE ORO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2004
Mailing Address - Country:US
Mailing Address - Phone:787-796-4688
Mailing Address - Fax:787-278-2660
Practice Address - Street 1:A4 CALLE MARGINAL
Practice Address - Street 2:COSTA DE ORO
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2004
Practice Address - Country:US
Practice Address - Phone:787-796-4688
Practice Address - Fax:787-278-2660
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054645122300000X
PR2909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist