Provider Demographics
NPI:1821449976
Name:MELANIE PUGH DMD, P.A. - GP
Entity Type:Organization
Organization Name:MELANIE PUGH DMD, P.A. - GP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-949-1805
Mailing Address - Street 1:8800 BERNWOOD PKWY
Mailing Address - Street 2:STE 4
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-9527
Mailing Address - Country:US
Mailing Address - Phone:239-949-1805
Mailing Address - Fax:239-949-1821
Practice Address - Street 1:8800 BERNWOOD PKWY
Practice Address - Street 2:STE 4
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-9527
Practice Address - Country:US
Practice Address - Phone:239-949-1805
Practice Address - Fax:239-949-1821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty