Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 17523 | MA |
NPI | 1023069507 |
---|---|
Provider Name | Dr. Carolyn Melita |
First Address | Belmont, MA 02478-4802 |
Second Address | Belmont, MA 02478-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 06/01/2017 |