Provider Demographics
NPI:1679829337
Name:MARIA N. MELLA DMD DENTAL CORP.
Entity Type:Organization
Organization Name:MARIA N. MELLA DMD DENTAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-274-1672
Mailing Address - Street 1:391 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2352
Mailing Address - Country:US
Mailing Address - Phone:619-274-1672
Mailing Address - Fax:
Practice Address - Street 1:391 SURREY DR
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2352
Practice Address - Country:US
Practice Address - Phone:619-274-1672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty