Provider Demographics
NPI:1770379117
Name:GOOD, MELINA (DMD)
Entity type:Individual
Prefix:DR
First Name:MELINA
Middle Name:
Last Name:GOOD
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 1:1300 FAIRMOUNT AVE UNIT 433
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2465
Mailing Address - Country:US
Mailing Address - Phone:570-760-4328
Mailing Address - Fax:
Practice Address - Street 1:159 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-5914
Practice Address - Country:US
Practice Address - Phone:856-848-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO449951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice