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General NPI Number Information
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NPI Number | 1386054013
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Entity Type | Organization
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Legal Business Name | BRETT B. MELGOSA DMD INC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 700 CRANE AVE
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City | TURLOCK
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State | CA
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Zip | 95380-4546
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Country | US
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Telephone | 209-634-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 700 CRANE AVE
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City | TURLOCK
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State | CA
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Zip | 95380-4546
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Country | US
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Telephone | 209-634-5858
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/CEO
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Name | DR. BRETT BREINIG MELGOSA
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Credential | D.M.D
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Telephone | 209-634-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 61429
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License Number State | CA
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