Provider Demographics
NPI:1679626659
Name:ELY, MELVA GARCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MELVA
Middle Name:GARCIA
Last Name:ELY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 W WATROUS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-4230
Mailing Address - Country:US
Mailing Address - Phone:813-287-2374
Mailing Address - Fax:
Practice Address - Street 1:4353 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1303
Practice Address - Country:US
Practice Address - Phone:813-805-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist