Provider Demographics
NPI:1720084742
Name:REYNARD, MELINDA MARGOLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:MARGOLIS
Last Name:REYNARD
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 1:1785 SAN CARLOS AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2026
Mailing Address - Country:US
Mailing Address - Phone:650-591-0995
Mailing Address - Fax:650-591-2431
Practice Address - Street 1:1785 SAN CARLOS AVE
Practice Address - Street 2:STE 3
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2026
Practice Address - Country:US
Practice Address - Phone:650-591-0995
Practice Address - Fax:650-591-2431
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist