MEDICARE: DR. MELISSA I OBROCHTA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN18067	FL

General Provider Information

NPI Number	:	1265621015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA I OBROCHTA D.M.D.

Provider Business Mailing Address
First Line	:	62 MATADOR LN
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-5542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15436 NW 77TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5822
Country	:	US
Telephone Number	:	305-557-5775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	09/08/2016

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