Provider Demographics
NPI:1548575483
Name:GABLE, MELINA RADA (DMD)
Entity type:Individual
Prefix:DR
First Name:MELINA
Middle Name:RADA
Last Name:GABLE
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 1:35 W JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3606
Mailing Address - Country:US
Mailing Address - Phone:706-654-2492
Mailing Address - Fax:
Practice Address - Street 1:35 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3606
Practice Address - Country:US
Practice Address - Phone:706-654-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist