Provider Demographics
NPI:1679564447
Name:QUIBA, MEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:
Last Name:QUIBA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E N ST
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2728
Mailing Address - Country:US
Mailing Address - Phone:707-745-0636
Mailing Address - Fax:707-745-0667
Practice Address - Street 1:125 E N ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2728
Practice Address - Country:US
Practice Address - Phone:707-745-0636
Practice Address - Fax:707-745-0667
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice