Healthcare Provider Details

I. General information

NPI: 1447186242
Provider Name (Legal Business Name): JOHANA LISSETTE MELENDEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR SPC 5831
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR SPC 5222
ANN ARBOR MI
48109-5222
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5950
  • Fax: 734-232-5015
Mailing address:
  • Phone: 734-232-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901602922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: