Provider Demographics
NPI:1629026430
Name:GARCIA-ROZAS, MELISSA VECENTIA (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:VECENTIA
Last Name:GARCIA-ROZAS
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 1:632 E SANDY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-3019
Mailing Address - Country:US
Mailing Address - Phone:972-393-9779
Mailing Address - Fax:972-393-9775
Practice Address - Street 1:632 E SANDY LAKE RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3019
Practice Address - Country:US
Practice Address - Phone:972-393-9779
Practice Address - Fax:972-393-9775
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111156904Medicaid