Provider Demographics
NPI:1659495331
Name:MELO, MARIA A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:MELO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE B VILLAS DE CAPARRA
Mailing Address - Street 2:#A-3
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00977
Mailing Address - Country:US
Mailing Address - Phone:787-783-1708
Mailing Address - Fax:787-723-8447
Practice Address - Street 1:BASIC DENTAL CLINIC
Practice Address - Street 2:AVE MUNOZ RIVERA 402
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice