Provider Demographics
NPI:1457546434
Name:MELANIE L. BOONE, DDS, PC
Entity type:Organization
Organization Name:MELANIE L. BOONE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-264-0224
Mailing Address - Street 1:5734 BROOK RD
Mailing Address - Street 2:BROOK RUN SHOPPING CENTER
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2276
Mailing Address - Country:US
Mailing Address - Phone:804-264-0224
Mailing Address - Fax:804-264-0229
Practice Address - Street 1:5734 BROOK RD
Practice Address - Street 2:BROOK RUN SHOPPING CENTER
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2276
Practice Address - Country:US
Practice Address - Phone:804-264-0224
Practice Address - Fax:804-264-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410483261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental