MEDICARE: DR. MELISSA MARIA RODAS D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	59437	CA

General Provider Information

NPI Number	:	1447563226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA MARIA RODAS D.D.S

Provider Business Mailing Address
First Line	:	19581 POMPANO LN UNIT 103
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6407
Country	:	US
Telephone Number	:	310-227-7339
Fax Number	:

Provider Business Practice Location Address
First Line	:	19581 POMPANO LN UNIT 103
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6407
Country	:	US
Telephone Number	:	310-227-7339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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