Healthcare Provider Details

I. General information

NPI: 1699137703
Provider Name (Legal Business Name): MELISSA MINGER DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR SUITE A-105
LA JOLLA CA
92037-1714
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR SUITE A-105
LA JOLLA CA
92037-1714
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-5520
  • Fax: 858-452-5525
Mailing address:
  • Phone: 858-452-5520
  • Fax: 858-452-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60260
License Number StateCA

VIII. Authorized Official

Name: MS. LINDA BRIGHT
Title or Position: OFFICE MANAGER
Credential: RDA
Phone: 858-742-5520