Provider Demographics
NPI:1801941398
Name:MELLADO, JOSE R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:MELLADO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 ALHAMBRA CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5116
Mailing Address - Country:US
Mailing Address - Phone:305-441-0302
Mailing Address - Fax:305-441-0177
Practice Address - Street 1:299 ALHAMBRA CIR STE 202
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5116
Practice Address - Country:US
Practice Address - Phone:305-441-0302
Practice Address - Fax:305-441-0177
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00147641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics