MEDICARE: MELANIE L. BOONE, DDS, PC

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	261QD0000X	Dental Clinic/Center	0401410483	VA

General Provider Information

NPI Number	:	1457546434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELANIE L. BOONE, DDS, PC

Provider Business Mailing Address
First Line	:	5734 BROOK RD
Second Line	:	BROOK RUN SHOPPING CENTER
City	:	RICHMOND
State	:	VA
Zip	:	23227-2276
Country	:	US
Telephone Number	:	804-264-0224
Fax Number	:	804-264-0229

Provider Business Practice Location Address
First Line	:	5734 BROOK RD
Second Line	:	BROOK RUN SHOPPING CENTER
City	:	RICHMOND
State	:	VA
Zip	:	23227-2276
Country	:	US
Telephone Number	:	804-264-0224
Fax Number	:	804-264-0229

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELANIE LYNN BOONE
Credential	:	DDS
Telephone Number	:	804-264-0224

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/12/2007

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