Provider Demographics
NPI:1942876115
Name:VUJICICH, MELODY ANN (RDHAP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:VUJICICH
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:ANN
Other - Last Name:VUJICICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDHAP
Mailing Address - Street 1:20041 OSTERMAN RD APT R14
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7790
Mailing Address - Country:US
Mailing Address - Phone:909-641-5922
Mailing Address - Fax:
Practice Address - Street 1:20041 OSTERMAN RD APT R14
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7790
Practice Address - Country:US
Practice Address - Phone:909-641-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA779124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist