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NPI Code Detail

MEDICARE: MICHAEL MELIZA D.D.S.

MEDICARE: MICHAEL MELIZA D.D.S.
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
11223G0001XGeneral Practice Dentistry12041TX

General Provider Information

NPI Number : 1902943574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL MELIZA D.D.S.
Provider Business Mailing Address
First Line : 1111 HERMANN DR
Second Line : #27C
City : HOUSTON
State : TX
Zip : 77004-7071
Country : US
Telephone Number : 713-521-9044
Fax Number :
Provider Business Practice Location Address
First Line : 310 W 19TH ST
Second Line :
City : HOUSTON
State : TX
Zip : 77008-3906
Country : US
Telephone Number : 713-861-6250
Fax Number : 713-869-6414
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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