Healthcare Provider Details

I. General information

NPI: 1225311889
Provider Name (Legal Business Name): BJORN MELANDER DDS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E BELL RD STE 150
PHOENIX AZ
85022-2348
US

IV. Provider business mailing address

PO BOX 3189
SYRACUSE NY
13220
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-5200
  • Fax: 602-374-4016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7790
License Number StateAZ

VIII. Authorized Official

Name: DR. BJORN MELANDER
Title or Position: OWNER
Credential: DDS
Phone: 866-273-8204