Provider Demographics
NPI:1669580239
Name:MELLION, DOUGLAS M (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:MELLION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42700 BOB HOPE DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4434
Mailing Address - Country:US
Mailing Address - Phone:760-779-0350
Mailing Address - Fax:760-779-0348
Practice Address - Street 1:42700 BOB HOPE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4434
Practice Address - Country:US
Practice Address - Phone:760-779-0350
Practice Address - Fax:760-779-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512241223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics