Provider Demographics
NPI:1982720058
Name:MELO, FABIANA (DDS)
Entity type:Individual
Prefix:
First Name:FABIANA
Middle Name:
Last Name:MELO
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 1:211 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4838
Mailing Address - Country:US
Mailing Address - Phone:650-589-4784
Mailing Address - Fax:650-589-4153
Practice Address - Street 1:485 BROADWAY STE 700
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1923
Practice Address - Country:US
Practice Address - Phone:650-576-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist