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General NPI Number Information
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NPI Number | 1902327448
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Entity Type | Individual
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Provider Name | MELISSA MARIE VEN DANGE DMD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 17041 BEACH BLVD STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6097
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Country | US
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Telephone | 714-594-5777
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Fax | 714-594-6511
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Provider Business Mailing Address
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Address Line | 10380 LA SOMBRA AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5209
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 104649
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License Number State | CA
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