| NPI | 1609242346 |
|---|---|
| Former Name | MELANIE MARIE REYES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64906) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64906) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2019-11-08 |