Provider Demographics
NPI:1427281377
Name:MELLA, MARIA NENITA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:NENITA
Last Name:MELLA
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 1:391 SURREY DRIVVE
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902
Mailing Address - Country:US
Mailing Address - Phone:619-274-1672
Mailing Address - Fax:619-434-9667
Practice Address - Street 1:3110 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3932
Practice Address - Country:US
Practice Address - Phone:619-274-1672
Practice Address - Fax:619-434-9667
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist