Provider Demographics
NPI:1740036086
Name:PMELO'S DENTAL GROUP & ASSOCIATES INC
Entity type:Organization
Organization Name:PMELO'S DENTAL GROUP & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PONCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:MELO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:415-418-9547
Mailing Address - Street 1:410 BARBER LN
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7914
Mailing Address - Country:US
Mailing Address - Phone:408-526-9999
Mailing Address - Fax:
Practice Address - Street 1:410 BARBER LN
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7914
Practice Address - Country:US
Practice Address - Phone:408-526-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty