Provider Demographics
NPI:1881044410
Name:BIRI, MELISSA (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BIRI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5645
Mailing Address - Country:US
Mailing Address - Phone:310-325-8888
Mailing Address - Fax:
Practice Address - Street 1:1730 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5645
Practice Address - Country:US
Practice Address - Phone:310-325-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH30178124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist