Provider Demographics
NPI:1730757329
Name:LIAN, MELINDA (DMD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:LIAN
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 1:10800 BRIGHTON BAY BLVD NE APT 11301
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-4404
Mailing Address - Country:US
Mailing Address - Phone:561-909-9797
Mailing Address - Fax:
Practice Address - Street 1:10800 BRIGHTON BAY BLVD NE APT 11301
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-4404
Practice Address - Country:US
Practice Address - Phone:561-909-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL259071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice