Provider Demographics
NPI:1699254680
Name:GHODS, MELINA (DMD)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:GHODS
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 1:419 W CALLE DE CABALLOS
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-5210
Mailing Address - Country:US
Mailing Address - Phone:480-284-9504
Mailing Address - Fax:
Practice Address - Street 1:419 WEST CALLE DE CABALLOS
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-8528
Practice Address - Country:US
Practice Address - Phone:480-284-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0101131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice