Provider Demographics
NPI:1952467623
Name:BARON, MELODY A (DDS)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:A
Last Name:BARON
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 1:3040 OASIS GRAND BLVD APT 804
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1536
Mailing Address - Country:US
Mailing Address - Phone:612-269-8717
Mailing Address - Fax:952-432-6886
Practice Address - Street 1:1616 CAPE CORAL PKWY W STE 115
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6973
Practice Address - Country:US
Practice Address - Phone:392-549-7771
Practice Address - Fax:239-205-8449
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND102341223G0001X
FLDN27359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice