Provider Demographics
NPI:1598901928
Name:MELISSA S. CHUN, DDS , A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MELISSA S. CHUN, DDS , A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:MELISSA S. CHUN, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-886-0688
Mailing Address - Street 1:2015 N WATERMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4810
Mailing Address - Country:US
Mailing Address - Phone:909-886-0688
Mailing Address - Fax:
Practice Address - Street 1:2015 N WATERMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4810
Practice Address - Country:US
Practice Address - Phone:909-886-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty