Healthcare Provider Details

I. General information

NPI: 1467076182
Provider Name (Legal Business Name): MELINA BJORNSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BUCK CREEK RD #305
AVON CO
81620
US

IV. Provider business mailing address

PO BOX 3386
AVON CO
81620-3386
US

V. Phone/Fax

Practice location:
  • Phone: 970-393-5128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberT-DEN.00000015
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: