Healthcare Provider Details

I. General information

NPI: 1609242346
Provider Name (Legal Business Name): MELANIE M GAGLIOTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE MARIE REYES

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 SALVIO ST.
CONCORD CA
94519
US

IV. Provider business mailing address

2955 SALVIO ST.
CONCORD CA
94519
US

V. Phone/Fax

Practice location:
  • Phone: 925-808-3456
  • Fax: 925-808-3455
Mailing address:
  • Phone: 925-808-3456
  • Fax: 925-808-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: