Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4777T | NV |
NPI | 1235106063 |
---|---|
Provider Name | Thomas Joseph Melendrez |
First Address | Reno, NV 89503-3672 |
Second Address | Reno, NV 89503-3672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 17/06/2013 |