Healthcare Provider Details

I. General information

NPI: 1265621015
Provider Name (Legal Business Name): MELISSA I OBROCHTA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15436 NW 77TH CT
MIAMI LAKES FL
33016-5822
US

IV. Provider business mailing address

62 MATADOR LN
DAVIE FL
33324-5542
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: