Provider Demographics
NPI:1982765434
Name:SCHAMP, MELANIE RENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RENE
Last Name:SCHAMP
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 1:1435 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4805
Mailing Address - Country:US
Mailing Address - Phone:407-644-5627
Mailing Address - Fax:407-644-6800
Practice Address - Street 1:1435 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4805
Practice Address - Country:US
Practice Address - Phone:407-644-5627
Practice Address - Fax:407-644-6800
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00133421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice