Provider Demographics
NPI:1588714414
Name:MELGUIZO, JUAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:MELGUIZO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MEADOWCREST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5256
Mailing Address - Country:US
Mailing Address - Phone:504-394-4990
Mailing Address - Fax:504-394-4903
Practice Address - Street 1:151 MEADOWCREST ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5256
Practice Address - Country:US
Practice Address - Phone:504-394-4990
Practice Address - Fax:504-394-4903
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA31791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice