Provider Demographics
NPI:1639906886
Name:JAIME, MELISSA JEAN (DDS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:JAIME
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 1:5880 FAIR ISLE DR APT 84
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8455
Mailing Address - Country:US
Mailing Address - Phone:808-228-0100
Mailing Address - Fax:
Practice Address - Street 1:15048 BEAR VALLEY RD STE H
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9235
Practice Address - Country:US
Practice Address - Phone:760-995-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist