Provider Demographics
NPI:1336268085
Name:PARKER, MELANIE SUE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SUE
Last Name:PARKER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:STE. A -303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-274-0777
Mailing Address - Fax:858-274-7604
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STE. A -303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-274-0777
Practice Address - Fax:858-274-7604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA412961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics