Provider Demographics
NPI:1720611163
Name:MELANIE KIM DENTAL CORPORATION
Entity Type:Organization
Organization Name:MELANIE KIM DENTAL CORPORATION
Other - Org Name:DENTISTS OF EL DORADO HILLS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-545-9449
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:303-222-0296
Mailing Address - Fax:
Practice Address - Street 1:3381 BASS LAKE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-545-9449
Practice Address - Fax:916-604-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty