Provider Demographics
NPI:1215282298
Name:CHURINETZ, MELANIE CECILE (DDS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:CECILE
Last Name:CHURINETZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:CECILE
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 N. ACADEMY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-442-0071
Mailing Address - Fax:719-473-5303
Practice Address - Street 1:833 NORTH ACADEMY BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-442-0071
Practice Address - Fax:719-473-5303
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist