Provider Demographics
NPI:1285951988
Name:SHABNAM MELAMED, DDS, PC
Entity type:Organization
Organization Name:SHABNAM MELAMED, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MELAMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-645-4313
Mailing Address - Street 1:6458 RHEA AVE # 133
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6024
Mailing Address - Country:US
Mailing Address - Phone:818-645-4313
Mailing Address - Fax:
Practice Address - Street 1:6458 RHEA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6024
Practice Address - Country:US
Practice Address - Phone:818-645-4313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty