Provider Demographics
NPI:1265971600
Name:MELKO DENTAL GROUP
Entity type:Organization
Organization Name:MELKO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MELKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-961-5975
Mailing Address - Street 1:100 W EL CAMINO REAL
Mailing Address - Street 2:SUITE 74A
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2664
Mailing Address - Country:US
Mailing Address - Phone:650-961-5975
Mailing Address - Fax:650-625-0468
Practice Address - Street 1:100 W EL CAMINO REAL
Practice Address - Street 2:SUITE 74A
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2664
Practice Address - Country:US
Practice Address - Phone:650-961-5975
Practice Address - Fax:650-625-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59565261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental