Provider Demographics
NPI:1801259791
Name:CORBLISS, MELANIE ROSE (DDS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:CORBLISS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ROSE
Other - Last Name:CULOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6395 DOBBIN ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4759
Mailing Address - Country:US
Mailing Address - Phone:410-997-9366
Mailing Address - Fax:410-715-1318
Practice Address - Street 1:6395 DOBBIN ROAD
Practice Address - Street 2:STE 210
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4759
Practice Address - Country:US
Practice Address - Phone:410-997-9366
Practice Address - Fax:410-715-1318
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD164931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice