Provider Demographics
NPI:1427127554
Name:MELENDEZ, MARIA ELOISA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELOISA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 CALLE JOSEMARIA ESCRIVA
Mailing Address - Street 2:EXT.ALHAMBRA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3811
Mailing Address - Country:US
Mailing Address - Phone:787-842-0338
Mailing Address - Fax:787-842-0338
Practice Address - Street 1:2909 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3613
Practice Address - Country:US
Practice Address - Phone:787-842-0338
Practice Address - Fax:787-842-0338
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice