Provider Demographics
NPI:1679711865
Name:MELGAR, DOUGLAS ENRIQUE (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ENRIQUE
Last Name:MELGAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ENRIQUE
Other - Middle Name:
Other - Last Name:MELGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE #1905
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-391-7751
Mailing Address - Fax:415-391-7357
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE #1905
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-391-7751
Practice Address - Fax:415-391-7357
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice