Provider Demographics
NPI:1295995454
Name:CHUN, MELISSA S (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:CHUN
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 1:2015 N WATERMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4810
Mailing Address - Country:US
Mailing Address - Phone:909-886-0688
Mailing Address - Fax:909-886-9652
Practice Address - Street 1:2015 N WATERMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4810
Practice Address - Country:US
Practice Address - Phone:909-886-0688
Practice Address - Fax:909-886-9652
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice