Provider Demographics
NPI:1609432400
Name:MELMED, VIRGINIA MCKENZIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MCKENZIE
Last Name:MELMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:MUALEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:120 BARBADOS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 BARBADOS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3511
Practice Address - Country:US
Practice Address - Phone:813-468-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN23093OtherFL LICENSE NUMBER