Provider Demographics
NPI:1265117816
Name:MELINA DENTAL, PC
Entity type:Organization
Organization Name:MELINA DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOYZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-495-7212
Mailing Address - Street 1:1240 S WESTLAKE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1990
Mailing Address - Country:US
Mailing Address - Phone:805-495-7212
Mailing Address - Fax:805-230-9218
Practice Address - Street 1:1240 S WESTLAKE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1990
Practice Address - Country:US
Practice Address - Phone:805-495-7212
Practice Address - Fax:805-230-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty