Provider Demographics
NPI:1972631455
Name:PUGH, MELANIE D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:D
Last Name:PUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 BERNWOOD PKWY
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 160491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice