Provider Demographics
NPI:1922786292
Name:RICHARD, MELANIE ROSE (DDS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CONSTITUTION AVE APT 346
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6000
Mailing Address - Country:US
Mailing Address - Phone:732-491-5961
Mailing Address - Fax:
Practice Address - Street 1:791 TURNER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6314
Practice Address - Country:US
Practice Address - Phone:207-777-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDEN5282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program