Healthcare Provider Details

I. General information

NPI: 1831594209
Provider Name (Legal Business Name): GENE MELNER DPD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 196TH ST SW
LYNNWOOD WA
98036-5052
US

IV. Provider business mailing address

7411 196TH ST SW
LYNNWOOD WA
98036-5052
US

V. Phone/Fax

Practice location:
  • Phone: 425-678-1166
  • Fax: 425-678-1167
Mailing address:
  • Phone: 425-678-1166
  • Fax: 425-678-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN60457532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: