Provider Demographics
NPI:1023108339
Name:MELENDEZ, RAFAEL A (DDS)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CALLE MENDEZ VIGO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4909
Mailing Address - Country:US
Mailing Address - Phone:787-796-4688
Mailing Address - Fax:787-278-2660
Practice Address - Street 1:322 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4909
Practice Address - Country:US
Practice Address - Phone:787-796-4688
Practice Address - Fax:787-278-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice