Provider Demographics
NPI:1134435811
Name:MELKO, SHAMIRAM AODISHO (DDS)
Entity type:Individual
Prefix:MRS
First Name:SHAMIRAM
Middle Name:AODISHO
Last Name:MELKO
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 1:2413 TEMESCAL DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9258
Mailing Address - Country:US
Mailing Address - Phone:209-450-5175
Mailing Address - Fax:
Practice Address - Street 1:100 W EL CAMINO REAL STE 74A
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2649
Practice Address - Country:US
Practice Address - Phone:650-961-5975
Practice Address - Fax:650-961-5975
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59565122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist