Provider Demographics
NPI:1306055967
Name:VALLEJOS, MELANIE BILBAENO (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:BILBAENO
Last Name:VALLEJOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 HOOKELE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3513
Mailing Address - Country:US
Mailing Address - Phone:808-877-8008
Mailing Address - Fax:808-877-8011
Practice Address - Street 1:89 HOOKELE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3513
Practice Address - Country:US
Practice Address - Phone:808-877-8008
Practice Address - Fax:808-877-8011
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT18321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice