Mark D. Mellman, DDS. PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

8712 Issued in FL

Legal business name

MARK D. MELLMAN, DDS. PA

Practice address

721 W Robertson St
Suite 107
Brandon, FL 33511-4934

Phone

(813) 654-4545

Fax

(813) 654-3470

NPI assigned

Jul 23, 2006

Last updated

Jul 16, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark David Mellman, DDSNPI 1700213188

Title

President

Phone

(813) 654-4545

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark David Mellman, DDS

  • Dentist
  • Brandon, FL
  • NPI 1700213188
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1578585451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 W ROBERTSON ST",
            "address_2": "SUITE 107",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114934",
            "telephone_number": "813-654-4545",
            "fax_number": "813-654-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 W ROBERTSON ST",
            "address_2": "SUITE 107",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114934",
            "telephone_number": "813-654-4545",
            "fax_number": "813-654-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D. MELLMAN, DDS. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "MELLMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-654-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "FL",
            "license": "8712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maravida Brandon MGT LLC
• William Srimuang Marconi
• Kristin Margetis, M.A., C.C.C.
• Erin Margie
• Marie L Fahringer, Ma, LMHC
• Mark G Leitner DPM (Advanced Foot and Ankle Specialists)
• Mark G Leitner DPM PA (Advanced Foot and Ankle Specialists)
• Mark Lee Craft MD PA
• Mark Taylor MD and Associates PA (o/o LENDEL M TAYLOR)
• Jordan Brooks Markel, MD

• Dental Clinic/Center in Brandon, FL
• Providers in Brandon, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.