Provider Demographics
NPI:1497194005
Name:MELANCON, TRINA (DMD)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:MELANCON
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 1:3930 S BRISTOL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7431
Mailing Address - Country:US
Mailing Address - Phone:714-546-9999
Mailing Address - Fax:714-546-0777
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 215
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-966-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist