Provider Demographics
NPI:1912234782
Name:MEINCKEN BOB, MELISSA (DDS)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MEINCKEN BOB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 S BISCAYNE BLVD APT 612
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-5358
Mailing Address - Country:US
Mailing Address - Phone:860-490-1173
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:786-624-3368
Practice Address - Fax:305-662-8314
Is Sole Proprietor?:No
Enumeration Date:2009-11-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN196041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006684000Medicaid