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General NPI Number Information
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NPI Number | 1679829337
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Entity Type | Organization
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Legal Business Name | MARIA N. MELLA DMD DENTAL CORP.
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 391 SURREY DR
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City | BONITA
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State | CA
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Zip | 91902-2352
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Country | US
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Telephone | 619-274-1672
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Fax |
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Provider Business Mailing Address
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Address Line | 391 SURREY DR
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City | BONITA
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State | CA
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Zip | 91902-2352
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Country | US
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Telephone | 619-274-1672
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA N MELLA
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Credential | DMD
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Telephone | 619-274-1672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44034
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License Number State | CA
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