Provider Demographics
NPI:1770643504
Name:PEREA-CORKISH, MELANIE MARTINEZ (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MARTINEZ
Last Name:PEREA-CORKISH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:MARTINEZ
Other - Last Name:PEREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4586
Mailing Address - Country:US
Mailing Address - Phone:415-441-7766
Mailing Address - Fax:
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4586
Practice Address - Country:US
Practice Address - Phone:415-441-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry