Provider Demographics
NPI:1588755805
Name:BOONE, MELANIE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LYNN
Last Name:BOONE
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 1:5734 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014104831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice