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General NPI Number Information
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NPI Number | 1265971600
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Entity Type | Organization
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Legal Business Name | MELKO DENTAL GROUP
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 100 W EL CAMINO REAL SUITE 74A
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2664
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Country | US
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Telephone | 650-961-5975
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Fax | 650-625-0468
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Provider Business Mailing Address
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Address Line | 100 W EL CAMINO REAL SUITE 74A
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2664
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Country | US
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Telephone | 650-961-5975
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Fax | 650-625-0468
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Authorized Official
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Title or Position | OWNER
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Name | SHAMIRAM MELKO
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Credential | D.D.S
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Telephone | 650-961-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 59565
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License Number State | CA
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