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General NPI Number Information
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NPI Number | 1083022107
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Entity Type | Individual
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Provider Name | MELLIZA GEORGE DDS
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Gender | Female
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 10611 GARLAND RD SUITE 205
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City | DALLAS
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State | TX
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Zip | 75218-2666
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Country | US
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Telephone | 214-321-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 SNOW CREEK DR
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City | THE COLONY
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State | TX
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Zip | 75056-3872
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Country | US
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Telephone | 405-246-6465
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30146
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License Number State | TX
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